hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|GA,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Candler County Hospital,2024-06-26,2.0.0,Candler County Hospital,"400 Cedar St, Metter, GA 30439",586004640,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|AMERIGROUP|MEDICAID|negotiated_dollar,standard_charge|AMERIGROUP|MEDICAID|negotiated_percentage,standard_charge|AMERIGROUP|MEDICAID|negotiated_algorithm,estimated_amount|AMERIGROUP|MEDICAID,standard_charge|AMERIGROUP|MEDICAID|methodology,additional_payer_notes|AMERIGROUP|MEDICAID,standard_charge|BCBS_HMO|COMMERCIAL|negotiated_dollar,standard_charge|BCBS_HMO|COMMERCIAL|negotiated_percentage,standard_charge|BCBS_HMO|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS_HMO|COMMERCIAL,standard_charge|BCBS_HMO|COMMERCIAL|methodology,additional_payer_notes|BCBS_HMO|COMMERCIAL,standard_charge|BCBS_HPN|COMMERCIAL|negotiated_dollar,standard_charge|BCBS_HPN|COMMERCIAL|negotiated_percentage,standard_charge|BCBS_HPN|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS_HPN|COMMERCIAL,standard_charge|BCBS_HPN|COMMERCIAL|methodology,additional_payer_notes|BCBS_HPN|COMMERCIAL,standard_charge|BCBS_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|BCBS_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|BCBS_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|BCBS_MEDICARE|MEDICARE,standard_charge|BCBS_MEDICARE|MEDICARE|methodology,additional_payer_notes|BCBS_MEDICARE|MEDICARE,standard_charge|BCBS_PATHWAY|COMMERCIAL|negotiated_dollar,standard_charge|BCBS_PATHWAY|COMMERCIAL|negotiated_percentage,standard_charge|BCBS_PATHWAY|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS_PATHWAY|COMMERCIAL,standard_charge|BCBS_PATHWAY|COMMERCIAL|methodology,additional_payer_notes|BCBS_PATHWAY|COMMERCIAL,standard_charge|BCBS_PPO|COMMERCIAL|negotiated_dollar,standard_charge|BCBS_PPO|COMMERCIAL|negotiated_percentage,standard_charge|BCBS_PPO|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS_PPO|COMMERCIAL,standard_charge|BCBS_PPO|COMMERCIAL|methodology,additional_payer_notes|BCBS_PPO|COMMERCIAL,standard_charge|CHOICECARE|COMMERCIAL|negotiated_dollar,standard_charge|CHOICECARE|COMMERCIAL|negotiated_percentage,standard_charge|CHOICECARE|COMMERCIAL|negotiated_algorithm,estimated_amount|CHOICECARE|COMMERCIAL,standard_charge|CHOICECARE|COMMERCIAL|methodology,additional_payer_notes|CHOICECARE|COMMERCIAL,standard_charge|CHOICECARE_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|CHOICECARE_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|CHOICECARE_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|CHOICECARE_MEDICARE|MEDICARE,standard_charge|CHOICECARE_MEDICARE|MEDICARE|methodology,additional_payer_notes|CHOICECARE_MEDICARE|MEDICARE,standard_charge|CIGNA|COMMERCIAL|negotiated_dollar,standard_charge|CIGNA|COMMERCIAL|negotiated_percentage,standard_charge|CIGNA|COMMERCIAL|negotiated_algorithm,estimated_amount|CIGNA|COMMERCIAL,standard_charge|CIGNA|COMMERCIAL|methodology,additional_payer_notes|CIGNA|COMMERCIAL,standard_charge|COVENTRY|COMMERCIAL|negotiated_dollar,standard_charge|COVENTRY|COMMERCIAL|negotiated_percentage,standard_charge|COVENTRY|COMMERCIAL|negotiated_algorithm,estimated_amount|COVENTRY|COMMERCIAL,standard_charge|COVENTRY|COMMERCIAL|methodology,additional_payer_notes|COVENTRY|COMMERCIAL,standard_charge|COVENTRY_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|COVENTRY_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|COVENTRY_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|COVENTRY_MEDICARE|MEDICARE,standard_charge|COVENTRY_MEDICARE|MEDICARE|methodology,additional_payer_notes|COVENTRY_MEDICARE|MEDICARE,standard_charge|MEDICAID|MEDICAID|negotiated_dollar,standard_charge|MEDICAID|MEDICAID|negotiated_percentage,standard_charge|MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|MEDICAID|MEDICAID,standard_charge|MEDICAID|MEDICAID|methodology,additional_payer_notes|MEDICAID|MEDICAID,standard_charge|MEDICARE|MEDICARE|negotiated_dollar,standard_charge|MEDICARE|MEDICARE|negotiated_percentage,standard_charge|MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|MEDICARE|MEDICARE,standard_charge|MEDICARE|MEDICARE|methodology,additional_payer_notes|MEDICARE|MEDICARE,standard_charge|PEACHSTATE|MEDICARE|negotiated_dollar,standard_charge|PEACHSTATE|MEDICARE|negotiated_percentage,standard_charge|PEACHSTATE|MEDICARE|negotiated_algorithm,estimated_amount|PEACHSTATE|MEDICARE,standard_charge|PEACHSTATE|MEDICARE|methodology,additional_payer_notes|PEACHSTATE|MEDICARE,standard_charge|UHC_HMO|COMMERCIAL|negotiated_dollar,standard_charge|UHC_HMO|COMMERCIAL|negotiated_percentage,standard_charge|UHC_HMO|COMMERCIAL|negotiated_algorithm,estimated_amount|UHC_HMO|COMMERCIAL,standard_charge|UHC_HMO|COMMERCIAL|methodology,additional_payer_notes|UHC_HMO|COMMERCIAL,standard_charge|UHC_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|UHC_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|UHC_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|UHC_MEDICARE|MEDICARE,standard_charge|UHC_MEDICARE|MEDICARE|methodology,additional_payer_notes|UHC_MEDICARE|MEDICARE,standard_charge|VACCN|MEDICARE|negotiated_dollar,standard_charge|VACCN|MEDICARE|negotiated_percentage,standard_charge|VACCN|MEDICARE|negotiated_algorithm,estimated_amount|VACCN|MEDICARE,standard_charge|VACCN|MEDICARE|methodology,additional_payer_notes|VACCN|MEDICARE,standard_charge|min,standard_charge|max,additional_generic_notes
VAPOTHERM ADULT CANNULA,170998,CDM,270,RC,,,Outpatient,,,103,51.5,,27.67,26.86,,,percent of total billed charges,26.86% of total billed charges,77.25,75,,,percent of total billed charges,75% of total billed charges ,77.25,75,,,percent of total billed charges,75% of total billed charges ,24.72,24,,,percent of total billed charges,24% of total billed charges ,77.25,75,,,percent of total billed charges,75% of total billed charges ,77.25,75,,,percent of total billed charges,75% of total billed charges ,82.4,80,,,percent of total billed charges,80% of total billed charges ,24.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,51.91,50.4,,,percent of total billed charges,50.4% of total billed charges ,77.25,75,,,percent of total billed charges,75% of total billed charges ,25.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.67,26.86,,,percent of total billed charges,26.86% of total billed charges,24.72,24,,,percent of total billed charges,24% of total billed charges ,32.14,31.2,,,percent of total billed charges,31.2% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,24.72,24,,,percent of total billed charges,24% of total billed charges ,24.72,24,,,percent of total billed charges,24% of total billed charges ,24.72,82.4,
VAPOTHERM HIGH FLOW NON-AEROSO CIRCUIT,170999,CDM,270,RC,,,Outpatient,,,179,89.5,,48.08,26.86,,,percent of total billed charges,26.86% of total billed charges,134.25,75,,,percent of total billed charges,75% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,42.96,24,,,percent of total billed charges,24% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,143.2,80,,,percent of total billed charges,80% of total billed charges ,43.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,90.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,43.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,48.08,26.86,,,percent of total billed charges,26.86% of total billed charges,42.96,24,,,percent of total billed charges,24% of total billed charges ,55.85,31.2,,,percent of total billed charges,31.2% of total billed charges,143.2,80,,,percent of total billed charges,80% of total billed charges,42.96,24,,,percent of total billed charges,24% of total billed charges ,42.96,24,,,percent of total billed charges,24% of total billed charges ,42.96,143.2,
CENTRAL LINE <5 YRS,233771,CDM,260,RC,36555,HCPCS,Outpatient,,,581,290.5,,156.06,26.86,,,percent of total billed charges,26.86% of total billed charges,435.75,75,,,percent of total billed charges,75% of total billed charges ,435.75,75,,,percent of total billed charges,75% of total billed charges ,139.44,24,,,percent of total billed charges,24% of total billed charges ,435.75,75,,,percent of total billed charges,75% of total billed charges ,435.75,75,,,percent of total billed charges,75% of total billed charges ,464.8,80,,,percent of total billed charges,80% of total billed charges ,140.83,24.24,,,percent of total billed charges,24.24% of total billed charges ,292.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,435.75,75,,,percent of total billed charges,75% of total billed charges ,142.23,24.48,,,percent of total billed charges,24.48% of total billed charges ,156.06,26.86,,,percent of total billed charges,26.86% of total billed charges,139.44,24,,,percent of total billed charges,24% of total billed charges ,181.27,31.2,,,percent of total billed charges,31.2% of total billed charges,464.8,80,,,percent of total billed charges,80% of total billed charges,139.44,24,,,percent of total billed charges,24% of total billed charges ,139.44,24,,,percent of total billed charges,24% of total billed charges ,139.44,464.8,
ERBE PROBE,254028,CDM,270,RC,,,Outpatient,,,533,266.5,,143.16,26.86,,,percent of total billed charges,26.86% of total billed charges,399.75,75,,,percent of total billed charges,75% of total billed charges ,399.75,75,,,percent of total billed charges,75% of total billed charges ,127.92,24,,,percent of total billed charges,24% of total billed charges ,399.75,75,,,percent of total billed charges,75% of total billed charges ,399.75,75,,,percent of total billed charges,75% of total billed charges ,426.4,80,,,percent of total billed charges,80% of total billed charges ,129.2,24.24,,,percent of total billed charges,24.24% of total billed charges ,268.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,399.75,75,,,percent of total billed charges,75% of total billed charges ,130.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,143.16,26.86,,,percent of total billed charges,26.86% of total billed charges,127.92,24,,,percent of total billed charges,24% of total billed charges ,166.3,31.2,,,percent of total billed charges,31.2% of total billed charges,426.4,80,,,percent of total billed charges,80% of total billed charges,127.92,24,,,percent of total billed charges,24% of total billed charges ,127.92,24,,,percent of total billed charges,24% of total billed charges ,127.92,426.4,
REPAIR INCARCERATED INGUINAL HERNIA  5+,280017,CDM,521,RC,49507,HCPCS,Outpatient,,,1511,755.5,,405.85,26.86,,,percent of total billed charges,26.86% of total billed charges,1133.25,75,,,percent of total billed charges,75% of total billed charges ,1133.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1133.25,75,,,percent of total billed charges,75% of total billed charges ,1133.25,75,,,percent of total billed charges,75% of total billed charges ,1208.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,761.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,1133.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,405.85,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1208.8,
MAINTENANCE OF WAKEFULNESS TEST,730000,CDM,740,RC,95805,HCPCS,Outpatient,,,3682.5,1841.25,,989.12,26.86,,,percent of total billed charges,26.86% of total billed charges,2761.88,75,,,percent of total billed charges,75% of total billed charges ,2761.88,75,,,percent of total billed charges,75% of total billed charges ,883.8,24,,,percent of total billed charges,24% of total billed charges ,2761.88,75,,,percent of total billed charges,75% of total billed charges ,2761.88,75,,,percent of total billed charges,75% of total billed charges ,2946,80,,,percent of total billed charges,80% of total billed charges ,892.64,24.24,,,percent of total billed charges,24.24% of total billed charges ,1855.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,2761.88,75,,,percent of total billed charges,75% of total billed charges ,901.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,989.12,26.86,,,percent of total billed charges,26.86% of total billed charges,883.8,24,,,percent of total billed charges,24% of total billed charges ,1148.94,31.2,,,percent of total billed charges,31.2% of total billed charges,2946,80,,,percent of total billed charges,80% of total billed charges,883.8,24,,,percent of total billed charges,24% of total billed charges ,883.8,24,,,percent of total billed charges,24% of total billed charges ,883.8,2946,
MULTIPLE SLEEP LATENCY TEST,730001,CDM,740,RC,95805,HCPCS,Outpatient,,,3676,1838,,987.37,26.86,,,percent of total billed charges,26.86% of total billed charges,2757,75,,,percent of total billed charges,75% of total billed charges ,2757,75,,,percent of total billed charges,75% of total billed charges ,882.24,24,,,percent of total billed charges,24% of total billed charges ,2757,75,,,percent of total billed charges,75% of total billed charges ,2757,75,,,percent of total billed charges,75% of total billed charges ,2940.8,80,,,percent of total billed charges,80% of total billed charges ,891.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,1852.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,2757,75,,,percent of total billed charges,75% of total billed charges ,899.88,24.48,,,percent of total billed charges,24.48% of total billed charges ,987.37,26.86,,,percent of total billed charges,26.86% of total billed charges,882.24,24,,,percent of total billed charges,24% of total billed charges ,1146.91,31.2,,,percent of total billed charges,31.2% of total billed charges,2940.8,80,,,percent of total billed charges,80% of total billed charges,882.24,24,,,percent of total billed charges,24% of total billed charges ,882.24,24,,,percent of total billed charges,24% of total billed charges ,882.24,2940.8,
POLYSOMNOGRAPHY P>4 ATTEND TECH,730002,CDM,740,RC,95810,HCPCS,Outpatient,,,3617.5,1808.75,,971.66,26.86,,,percent of total billed charges,26.86% of total billed charges,2713.13,75,,,percent of total billed charges,75% of total billed charges ,2713.13,75,,,percent of total billed charges,75% of total billed charges ,868.2,24,,,percent of total billed charges,24% of total billed charges ,2713.13,75,,,percent of total billed charges,75% of total billed charges ,2713.13,75,,,percent of total billed charges,75% of total billed charges ,2894,80,,,percent of total billed charges,80% of total billed charges ,876.88,24.24,,,percent of total billed charges,24.24% of total billed charges ,1823.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,2713.13,75,,,percent of total billed charges,75% of total billed charges ,885.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,971.66,26.86,,,percent of total billed charges,26.86% of total billed charges,868.2,24,,,percent of total billed charges,24% of total billed charges ,1128.66,31.2,,,percent of total billed charges,31.2% of total billed charges,2894,80,,,percent of total billed charges,80% of total billed charges,868.2,24,,,percent of total billed charges,24% of total billed charges ,868.2,24,,,percent of total billed charges,24% of total billed charges ,868.2,2894,
POLYSOMNOGRAPHY P >4 INIT CPAP,730003,CDM,740,RC,95811,HCPCS,Outpatient,,,4567,2283.5,,1226.7,26.86,,,percent of total billed charges,26.86% of total billed charges,3425.25,75,,,percent of total billed charges,75% of total billed charges ,3425.25,75,,,percent of total billed charges,75% of total billed charges ,1096.08,24,,,percent of total billed charges,24% of total billed charges ,3425.25,75,,,percent of total billed charges,75% of total billed charges ,3425.25,75,,,percent of total billed charges,75% of total billed charges ,3653.6,80,,,percent of total billed charges,80% of total billed charges ,1107.04,24.24,,,percent of total billed charges,24.24% of total billed charges ,2301.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,3425.25,75,,,percent of total billed charges,75% of total billed charges ,1118,24.48,,,percent of total billed charges,24.48% of total billed charges ,1226.7,26.86,,,percent of total billed charges,26.86% of total billed charges,1096.08,24,,,percent of total billed charges,24% of total billed charges ,1424.9,31.2,,,percent of total billed charges,31.2% of total billed charges,3653.6,80,,,percent of total billed charges,80% of total billed charges,1096.08,24,,,percent of total billed charges,24% of total billed charges ,1096.08,24,,,percent of total billed charges,24% of total billed charges ,1096.08,3653.6,
SLEEP STUDY UNATTENDED,730004,CDM,740,RC,95806,HCPCS,Outpatient,,,724,362,,194.47,26.86,,,percent of total billed charges,26.86% of total billed charges,543,75,,,percent of total billed charges,75% of total billed charges ,543,75,,,percent of total billed charges,75% of total billed charges ,173.76,24,,,percent of total billed charges,24% of total billed charges ,543,75,,,percent of total billed charges,75% of total billed charges ,543,75,,,percent of total billed charges,75% of total billed charges ,579.2,80,,,percent of total billed charges,80% of total billed charges ,175.5,24.24,,,percent of total billed charges,24.24% of total billed charges ,364.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,543,75,,,percent of total billed charges,75% of total billed charges ,177.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,194.47,26.86,,,percent of total billed charges,26.86% of total billed charges,173.76,24,,,percent of total billed charges,24% of total billed charges ,225.89,31.2,,,percent of total billed charges,31.2% of total billed charges,579.2,80,,,percent of total billed charges,80% of total billed charges,173.76,24,,,percent of total billed charges,24% of total billed charges ,173.76,24,,,percent of total billed charges,24% of total billed charges ,173.76,579.2,
TERMINATED CPAP 3-4 HR,730005,CDM,740,RC,95811,HCPCS,Outpatient,,,2779,1389.5,,746.44,26.86,,,percent of total billed charges,26.86% of total billed charges,2084.25,75,,,percent of total billed charges,75% of total billed charges ,2084.25,75,,,percent of total billed charges,75% of total billed charges ,666.96,24,,,percent of total billed charges,24% of total billed charges ,2084.25,75,,,percent of total billed charges,75% of total billed charges ,2084.25,75,,,percent of total billed charges,75% of total billed charges ,2223.2,80,,,percent of total billed charges,80% of total billed charges ,673.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,1400.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,2084.25,75,,,percent of total billed charges,75% of total billed charges ,680.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,746.44,26.86,,,percent of total billed charges,26.86% of total billed charges,666.96,24,,,percent of total billed charges,24% of total billed charges ,867.05,31.2,,,percent of total billed charges,31.2% of total billed charges,2223.2,80,,,percent of total billed charges,80% of total billed charges,666.96,24,,,percent of total billed charges,24% of total billed charges ,666.96,24,,,percent of total billed charges,24% of total billed charges ,666.96,2223.2,
TERMINATED CPAP STUDY 1-2 HR,730006,CDM,740,RC,95811,HCPCS,Outpatient,,,1455.5,727.75,,390.95,26.86,,,percent of total billed charges,26.86% of total billed charges,1091.63,75,,,percent of total billed charges,75% of total billed charges ,1091.63,75,,,percent of total billed charges,75% of total billed charges ,349.32,24,,,percent of total billed charges,24% of total billed charges ,1091.63,75,,,percent of total billed charges,75% of total billed charges ,1091.63,75,,,percent of total billed charges,75% of total billed charges ,1164.4,80,,,percent of total billed charges,80% of total billed charges ,352.81,24.24,,,percent of total billed charges,24.24% of total billed charges ,733.57,50.4,,,percent of total billed charges,50.4% of total billed charges ,1091.63,75,,,percent of total billed charges,75% of total billed charges ,356.31,24.48,,,percent of total billed charges,24.48% of total billed charges ,390.95,26.86,,,percent of total billed charges,26.86% of total billed charges,349.32,24,,,percent of total billed charges,24% of total billed charges ,454.12,31.2,,,percent of total billed charges,31.2% of total billed charges,1164.4,80,,,percent of total billed charges,80% of total billed charges,349.32,24,,,percent of total billed charges,24% of total billed charges ,349.32,24,,,percent of total billed charges,24% of total billed charges ,349.32,1164.4,
TERMINATED SLEEP STUDY 1-2 HR,730007,CDM,740,RC,95810,HCPCS,Outpatient,,,1059,529.5,,284.45,26.86,,,percent of total billed charges,26.86% of total billed charges,794.25,75,,,percent of total billed charges,75% of total billed charges ,794.25,75,,,percent of total billed charges,75% of total billed charges ,254.16,24,,,percent of total billed charges,24% of total billed charges ,794.25,75,,,percent of total billed charges,75% of total billed charges ,794.25,75,,,percent of total billed charges,75% of total billed charges ,847.2,80,,,percent of total billed charges,80% of total billed charges ,256.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,533.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,794.25,75,,,percent of total billed charges,75% of total billed charges ,259.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,284.45,26.86,,,percent of total billed charges,26.86% of total billed charges,254.16,24,,,percent of total billed charges,24% of total billed charges ,330.41,31.2,,,percent of total billed charges,31.2% of total billed charges,847.2,80,,,percent of total billed charges,80% of total billed charges,254.16,24,,,percent of total billed charges,24% of total billed charges ,254.16,24,,,percent of total billed charges,24% of total billed charges ,254.16,847.2,
TERMINATD SLEEP STUDY 3-4 HR,730008,CDM,740,RC,95810,HCPCS,Outpatient,,,1984,992,,532.9,26.86,,,percent of total billed charges,26.86% of total billed charges,1488,75,,,percent of total billed charges,75% of total billed charges ,1488,75,,,percent of total billed charges,75% of total billed charges ,476.16,24,,,percent of total billed charges,24% of total billed charges ,1488,75,,,percent of total billed charges,75% of total billed charges ,1488,75,,,percent of total billed charges,75% of total billed charges ,1587.2,80,,,percent of total billed charges,80% of total billed charges ,480.92,24.24,,,percent of total billed charges,24.24% of total billed charges ,999.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,1488,75,,,percent of total billed charges,75% of total billed charges ,485.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,532.9,26.86,,,percent of total billed charges,26.86% of total billed charges,476.16,24,,,percent of total billed charges,24% of total billed charges ,619.01,31.2,,,percent of total billed charges,31.2% of total billed charges,1587.2,80,,,percent of total billed charges,80% of total billed charges,476.16,24,,,percent of total billed charges,24% of total billed charges ,476.16,24,,,percent of total billed charges,24% of total billed charges ,476.16,1587.2,
PAP NAP,730009,CDM,740,RC,95807,HCPCS,Outpatient,,,585,292.5,,157.13,26.86,,,percent of total billed charges,26.86% of total billed charges,438.75,75,,,percent of total billed charges,75% of total billed charges ,438.75,75,,,percent of total billed charges,75% of total billed charges ,140.4,24,,,percent of total billed charges,24% of total billed charges ,438.75,75,,,percent of total billed charges,75% of total billed charges ,438.75,75,,,percent of total billed charges,75% of total billed charges ,468,80,,,percent of total billed charges,80% of total billed charges ,141.8,24.24,,,percent of total billed charges,24.24% of total billed charges ,294.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,438.75,75,,,percent of total billed charges,75% of total billed charges ,143.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,157.13,26.86,,,percent of total billed charges,26.86% of total billed charges,140.4,24,,,percent of total billed charges,24% of total billed charges ,182.52,31.2,,,percent of total billed charges,31.2% of total billed charges,468,80,,,percent of total billed charges,80% of total billed charges,140.4,24,,,percent of total billed charges,24% of total billed charges ,140.4,24,,,percent of total billed charges,24% of total billed charges ,140.4,468,
ABSCESS I&D,890000,CDM,761,RC,10061,HCPCS,Outpatient,,,357.5,178.75,,96.02,26.86,,,percent of total billed charges,26.86% of total billed charges,268.13,75,,,percent of total billed charges,75% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,85.8,24,,,percent of total billed charges,24% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,286,80,,,percent of total billed charges,80% of total billed charges ,86.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,180.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,87.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,96.02,26.86,,,percent of total billed charges,26.86% of total billed charges,85.8,24,,,percent of total billed charges,24% of total billed charges ,111.54,31.2,,,percent of total billed charges,31.2% of total billed charges,286,80,,,percent of total billed charges,80% of total billed charges,85.8,24,,,percent of total billed charges,24% of total billed charges ,85.8,24,,,percent of total billed charges,24% of total billed charges ,85.8,286,
BRIEF OUTPATIENT SIMPLE,890001,CDM,761,RC,99211,HCPCS,Outpatient,,,156.5,78.25,,42.04,26.86,,,percent of total billed charges,26.86% of total billed charges,117.38,75,,,percent of total billed charges,75% of total billed charges ,117.38,75,,,percent of total billed charges,75% of total billed charges ,37.56,24,,,percent of total billed charges,24% of total billed charges ,117.38,75,,,percent of total billed charges,75% of total billed charges ,117.38,75,,,percent of total billed charges,75% of total billed charges ,125.2,80,,,percent of total billed charges,80% of total billed charges ,37.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,78.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,117.38,75,,,percent of total billed charges,75% of total billed charges ,38.31,24.48,,,percent of total billed charges,24.48% of total billed charges ,42.04,26.86,,,percent of total billed charges,26.86% of total billed charges,37.56,24,,,percent of total billed charges,24% of total billed charges ,48.83,31.2,,,percent of total billed charges,31.2% of total billed charges,125.2,80,,,percent of total billed charges,80% of total billed charges,37.56,24,,,percent of total billed charges,24% of total billed charges ,37.56,24,,,percent of total billed charges,24% of total billed charges ,37.56,125.2,
CENTRAL LINE FLUSH,890004,CDM,761,RC,96523,HCPCS,Outpatient,,,236,118,,63.39,26.86,,,percent of total billed charges,26.86% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges ,177,75,,,percent of total billed charges,75% of total billed charges ,56.64,24,,,percent of total billed charges,24% of total billed charges ,177,75,,,percent of total billed charges,75% of total billed charges ,177,75,,,percent of total billed charges,75% of total billed charges ,188.8,80,,,percent of total billed charges,80% of total billed charges ,57.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,118.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,177,75,,,percent of total billed charges,75% of total billed charges ,57.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.39,26.86,,,percent of total billed charges,26.86% of total billed charges,56.64,24,,,percent of total billed charges,24% of total billed charges ,73.63,31.2,,,percent of total billed charges,31.2% of total billed charges,188.8,80,,,percent of total billed charges,80% of total billed charges,56.64,24,,,percent of total billed charges,24% of total billed charges ,56.64,24,,,percent of total billed charges,24% of total billed charges ,56.64,188.8,
CENTRAL LINE REMOVAL,890005,CDM,761,RC,36589,HCPCS,Outpatient,,,85.5,42.75,,22.97,26.86,,,percent of total billed charges,26.86% of total billed charges,64.13,75,,,percent of total billed charges,75% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,20.52,24,,,percent of total billed charges,24% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,68.4,80,,,percent of total billed charges,80% of total billed charges ,20.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,43.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,20.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.97,26.86,,,percent of total billed charges,26.86% of total billed charges,20.52,24,,,percent of total billed charges,24% of total billed charges ,26.68,31.2,,,percent of total billed charges,31.2% of total billed charges,68.4,80,,,percent of total billed charges,80% of total billed charges,20.52,24,,,percent of total billed charges,24% of total billed charges ,20.52,24,,,percent of total billed charges,24% of total billed charges ,20.52,68.4,
CONSTIPATION REMOVAL,890006,CDM,761,RC,,,Outpatient,,,224.5,112.25,,60.3,26.86,,,percent of total billed charges,26.86% of total billed charges,168.38,75,,,percent of total billed charges,75% of total billed charges ,168.38,75,,,percent of total billed charges,75% of total billed charges ,53.88,24,,,percent of total billed charges,24% of total billed charges ,168.38,75,,,percent of total billed charges,75% of total billed charges ,168.38,75,,,percent of total billed charges,75% of total billed charges ,179.6,80,,,percent of total billed charges,80% of total billed charges ,54.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,113.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,168.38,75,,,percent of total billed charges,75% of total billed charges ,54.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,60.3,26.86,,,percent of total billed charges,26.86% of total billed charges,53.88,24,,,percent of total billed charges,24% of total billed charges ,70.04,31.2,,,percent of total billed charges,31.2% of total billed charges,179.6,80,,,percent of total billed charges,80% of total billed charges,53.88,24,,,percent of total billed charges,24% of total billed charges ,53.88,24,,,percent of total billed charges,24% of total billed charges ,53.88,179.6,
CYST DRAINAGE SIMPLE,890007,CDM,761,RC,10080,HCPCS,Outpatient,,,245,122.5,,65.81,26.86,,,percent of total billed charges,26.86% of total billed charges,183.75,75,,,percent of total billed charges,75% of total billed charges ,183.75,75,,,percent of total billed charges,75% of total billed charges ,58.8,24,,,percent of total billed charges,24% of total billed charges ,183.75,75,,,percent of total billed charges,75% of total billed charges ,183.75,75,,,percent of total billed charges,75% of total billed charges ,196,80,,,percent of total billed charges,80% of total billed charges ,59.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,123.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,183.75,75,,,percent of total billed charges,75% of total billed charges ,59.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,65.81,26.86,,,percent of total billed charges,26.86% of total billed charges,58.8,24,,,percent of total billed charges,24% of total billed charges ,76.44,31.2,,,percent of total billed charges,31.2% of total billed charges,196,80,,,percent of total billed charges,80% of total billed charges,58.8,24,,,percent of total billed charges,24% of total billed charges ,58.8,24,,,percent of total billed charges,24% of total billed charges ,58.8,196,
CYST REMOVAL SIMPLE,890008,CDM,761,RC,10040,HCPCS,Outpatient,,,279,139.5,,74.94,26.86,,,percent of total billed charges,26.86% of total billed charges,209.25,75,,,percent of total billed charges,75% of total billed charges ,209.25,75,,,percent of total billed charges,75% of total billed charges ,66.96,24,,,percent of total billed charges,24% of total billed charges ,209.25,75,,,percent of total billed charges,75% of total billed charges ,209.25,75,,,percent of total billed charges,75% of total billed charges ,223.2,80,,,percent of total billed charges,80% of total billed charges ,67.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,140.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,209.25,75,,,percent of total billed charges,75% of total billed charges ,68.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,74.94,26.86,,,percent of total billed charges,26.86% of total billed charges,66.96,24,,,percent of total billed charges,24% of total billed charges ,87.05,31.2,,,percent of total billed charges,31.2% of total billed charges,223.2,80,,,percent of total billed charges,80% of total billed charges,66.96,24,,,percent of total billed charges,24% of total billed charges ,66.96,24,,,percent of total billed charges,24% of total billed charges ,66.96,223.2,
DIRECT ADMIT OBSERVA,890009,CDM,762,RC,G0379,HCPCS,Outpatient,,,172,86,,46.2,26.86,,,percent of total billed charges,26.86% of total billed charges,129,75,,,percent of total billed charges,75% of total billed charges ,129,75,,,percent of total billed charges,75% of total billed charges ,41.28,24,,,percent of total billed charges,24% of total billed charges ,129,75,,,percent of total billed charges,75% of total billed charges ,129,75,,,percent of total billed charges,75% of total billed charges ,137.6,80,,,percent of total billed charges,80% of total billed charges ,41.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,86.69,50.4,,,percent of total billed charges,50.4% of total billed charges ,129,75,,,percent of total billed charges,75% of total billed charges ,42.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,46.2,26.86,,,percent of total billed charges,26.86% of total billed charges,41.28,24,,,percent of total billed charges,24% of total billed charges ,53.66,31.2,,,percent of total billed charges,31.2% of total billed charges,137.6,80,,,percent of total billed charges,80% of total billed charges,41.28,24,,,percent of total billed charges,24% of total billed charges ,41.28,24,,,percent of total billed charges,24% of total billed charges ,41.28,137.6,
OBSERVATION HOUR,890010,CDM,762,RC,G0378,HCPCS,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
OBSERVATION HOUR TELEMETRY,890011,CDM,762,RC,G0378,HCPCS,Outpatient,,,62,31,,16.65,26.86,,,percent of total billed charges,26.86% of total billed charges,46.5,75,,,percent of total billed charges,75% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,14.88,24,,,percent of total billed charges,24% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,49.6,80,,,percent of total billed charges,80% of total billed charges ,15.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,15.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.65,26.86,,,percent of total billed charges,26.86% of total billed charges,14.88,24,,,percent of total billed charges,24% of total billed charges ,19.34,31.2,,,percent of total billed charges,31.2% of total billed charges,49.6,80,,,percent of total billed charges,80% of total billed charges,14.88,24,,,percent of total billed charges,24% of total billed charges ,14.88,24,,,percent of total billed charges,24% of total billed charges ,14.88,49.6,
FB REMOVAL SIMPLE,890012,CDM,761,RC,,,Outpatient,,,78.5,39.25,,21.09,26.86,,,percent of total billed charges,26.86% of total billed charges,58.88,75,,,percent of total billed charges,75% of total billed charges ,58.88,75,,,percent of total billed charges,75% of total billed charges ,18.84,24,,,percent of total billed charges,24% of total billed charges ,58.88,75,,,percent of total billed charges,75% of total billed charges ,58.88,75,,,percent of total billed charges,75% of total billed charges ,62.8,80,,,percent of total billed charges,80% of total billed charges ,19.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.88,75,,,percent of total billed charges,75% of total billed charges ,19.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.09,26.86,,,percent of total billed charges,26.86% of total billed charges,18.84,24,,,percent of total billed charges,24% of total billed charges ,24.49,31.2,,,percent of total billed charges,31.2% of total billed charges,62.8,80,,,percent of total billed charges,80% of total billed charges,18.84,24,,,percent of total billed charges,24% of total billed charges ,18.84,24,,,percent of total billed charges,24% of total billed charges ,18.84,62.8,
FB REMOVAL INTERMEDI,890013,CDM,761,RC,,,Outpatient,,,122.5,61.25,,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,98,80,,,percent of total billed charges,80% of total billed charges ,29.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,38.22,31.2,,,percent of total billed charges,31.2% of total billed charges,98,80,,,percent of total billed charges,80% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,98,
FB REMOVAL COMPLEX,890014,CDM,761,RC,,,Outpatient,,,178,89,,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,142.4,
I&D HEMATOMA,890016,CDM,761,RC,10140,HCPCS,Outpatient,,,225.5,112.75,,60.57,26.86,,,percent of total billed charges,26.86% of total billed charges,169.13,75,,,percent of total billed charges,75% of total billed charges ,169.13,75,,,percent of total billed charges,75% of total billed charges ,54.12,24,,,percent of total billed charges,24% of total billed charges ,169.13,75,,,percent of total billed charges,75% of total billed charges ,169.13,75,,,percent of total billed charges,75% of total billed charges ,180.4,80,,,percent of total billed charges,80% of total billed charges ,54.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,113.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,169.13,75,,,percent of total billed charges,75% of total billed charges ,55.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,60.57,26.86,,,percent of total billed charges,26.86% of total billed charges,54.12,24,,,percent of total billed charges,24% of total billed charges ,70.36,31.2,,,percent of total billed charges,31.2% of total billed charges,180.4,80,,,percent of total billed charges,80% of total billed charges,54.12,24,,,percent of total billed charges,24% of total billed charges ,54.12,24,,,percent of total billed charges,24% of total billed charges ,54.12,180.4,
IN & OUT CATH,890017,CDM,761,RC,P9612,HCPCS,Outpatient,,,45.5,22.75,,12.22,26.86,,,percent of total billed charges,26.86% of total billed charges,34.13,75,,,percent of total billed charges,75% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.22,26.86,,,percent of total billed charges,26.86% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,36.4,80,,,percent of total billed charges,80% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,36.4,
G TUBE INSERTION,890018,CDM,761,RC,43762,HCPCS,Outpatient,,,170,85,,45.66,26.86,,,percent of total billed charges,26.86% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,40.8,24,,,percent of total billed charges,24% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,136,80,,,percent of total billed charges,80% of total billed charges ,41.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,85.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,41.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,45.66,26.86,,,percent of total billed charges,26.86% of total billed charges,40.8,24,,,percent of total billed charges,24% of total billed charges ,53.04,31.2,,,percent of total billed charges,31.2% of total billed charges,136,80,,,percent of total billed charges,80% of total billed charges,40.8,24,,,percent of total billed charges,24% of total billed charges ,40.8,24,,,percent of total billed charges,24% of total billed charges ,40.8,136,
CAPNOGRAPHY,890019,CDM,761,RC,94760,HCPCS,Outpatient,,,61,30.5,,16.38,26.86,,,percent of total billed charges,26.86% of total billed charges,45.75,75,,,percent of total billed charges,75% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,14.64,24,,,percent of total billed charges,24% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,48.8,80,,,percent of total billed charges,80% of total billed charges ,14.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,30.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,14.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.38,26.86,,,percent of total billed charges,26.86% of total billed charges,14.64,24,,,percent of total billed charges,24% of total billed charges ,19.03,31.2,,,percent of total billed charges,31.2% of total billed charges,48.8,80,,,percent of total billed charges,80% of total billed charges,14.64,24,,,percent of total billed charges,24% of total billed charges ,14.64,24,,,percent of total billed charges,24% of total billed charges ,14.64,48.8,
SPINAL/LUMBAR PUNCTU,890020,CDM,761,RC,62270,HCPCS,Outpatient,,,557,278.5,,149.61,26.86,,,percent of total billed charges,26.86% of total billed charges,417.75,75,,,percent of total billed charges,75% of total billed charges ,417.75,75,,,percent of total billed charges,75% of total billed charges ,133.68,24,,,percent of total billed charges,24% of total billed charges ,417.75,75,,,percent of total billed charges,75% of total billed charges ,417.75,75,,,percent of total billed charges,75% of total billed charges ,445.6,80,,,percent of total billed charges,80% of total billed charges ,135.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,280.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,417.75,75,,,percent of total billed charges,75% of total billed charges ,136.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,149.61,26.86,,,percent of total billed charges,26.86% of total billed charges,133.68,24,,,percent of total billed charges,24% of total billed charges ,173.78,31.2,,,percent of total billed charges,31.2% of total billed charges,445.6,80,,,percent of total billed charges,80% of total billed charges,133.68,24,,,percent of total billed charges,24% of total billed charges ,133.68,24,,,percent of total billed charges,24% of total billed charges ,133.68,445.6,
TRIGGER POINT INJECT,890021,CDM,761,RC,20552,HCPCS,Outpatient,,,314,157,,84.34,26.86,,,percent of total billed charges,26.86% of total billed charges,235.5,75,,,percent of total billed charges,75% of total billed charges ,235.5,75,,,percent of total billed charges,75% of total billed charges ,75.36,24,,,percent of total billed charges,24% of total billed charges ,235.5,75,,,percent of total billed charges,75% of total billed charges ,235.5,75,,,percent of total billed charges,75% of total billed charges ,251.2,80,,,percent of total billed charges,80% of total billed charges ,76.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,158.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,235.5,75,,,percent of total billed charges,75% of total billed charges ,76.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,84.34,26.86,,,percent of total billed charges,26.86% of total billed charges,75.36,24,,,percent of total billed charges,24% of total billed charges ,97.97,31.2,,,percent of total billed charges,31.2% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,75.36,24,,,percent of total billed charges,24% of total billed charges ,75.36,24,,,percent of total billed charges,24% of total billed charges ,75.36,251.2,
IM INJECTION ANTIBIO,890023,CDM,260,RC,96372,HCPCS,Outpatient,,,157.5,78.75,,42.3,26.86,,,percent of total billed charges,26.86% of total billed charges,118.13,75,,,percent of total billed charges,75% of total billed charges ,118.13,75,,,percent of total billed charges,75% of total billed charges ,37.8,24,,,percent of total billed charges,24% of total billed charges ,118.13,75,,,percent of total billed charges,75% of total billed charges ,118.13,75,,,percent of total billed charges,75% of total billed charges ,126,80,,,percent of total billed charges,80% of total billed charges ,38.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,79.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,118.13,75,,,percent of total billed charges,75% of total billed charges ,38.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,42.3,26.86,,,percent of total billed charges,26.86% of total billed charges,37.8,24,,,percent of total billed charges,24% of total billed charges ,49.14,31.2,,,percent of total billed charges,31.2% of total billed charges,126,80,,,percent of total billed charges,80% of total billed charges,37.8,24,,,percent of total billed charges,24% of total billed charges ,37.8,24,,,percent of total billed charges,24% of total billed charges ,37.8,126,
IV PUSH INITIAL,890024,CDM,260,RC,96374,HCPCS,Outpatient,,,245,122.5,,65.81,26.86,,,percent of total billed charges,26.86% of total billed charges,183.75,75,,,percent of total billed charges,75% of total billed charges ,183.75,75,,,percent of total billed charges,75% of total billed charges ,58.8,24,,,percent of total billed charges,24% of total billed charges ,183.75,75,,,percent of total billed charges,75% of total billed charges ,183.75,75,,,percent of total billed charges,75% of total billed charges ,196,80,,,percent of total billed charges,80% of total billed charges ,59.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,123.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,183.75,75,,,percent of total billed charges,75% of total billed charges ,59.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,65.81,26.86,,,percent of total billed charges,26.86% of total billed charges,58.8,24,,,percent of total billed charges,24% of total billed charges ,76.44,31.2,,,percent of total billed charges,31.2% of total billed charges,196,80,,,percent of total billed charges,80% of total billed charges,58.8,24,,,percent of total billed charges,24% of total billed charges ,58.8,24,,,percent of total billed charges,24% of total billed charges ,58.8,196,
IV PUSH SAME DRUG,890025,CDM,260,RC,96376,HCPCS,Outpatient,,,210,105,,56.41,26.86,,,percent of total billed charges,26.86% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,50.4,24,,,percent of total billed charges,24% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,168,80,,,percent of total billed charges,80% of total billed charges ,50.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,105.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,51.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,56.41,26.86,,,percent of total billed charges,26.86% of total billed charges,50.4,24,,,percent of total billed charges,24% of total billed charges ,65.52,31.2,,,percent of total billed charges,31.2% of total billed charges,168,80,,,percent of total billed charges,80% of total billed charges,50.4,24,,,percent of total billed charges,24% of total billed charges ,50.4,24,,,percent of total billed charges,24% of total billed charges ,50.4,168,
IV PUSH SUBSEQUENT,890026,CDM,260,RC,96375,HCPCS,Outpatient,,,141,70.5,,37.87,26.86,,,percent of total billed charges,26.86% of total billed charges,105.75,75,,,percent of total billed charges,75% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,112.8,80,,,percent of total billed charges,80% of total billed charges ,34.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,71.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,34.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.87,26.86,,,percent of total billed charges,26.86% of total billed charges,33.84,24,,,percent of total billed charges,24% of total billed charges ,43.99,31.2,,,percent of total billed charges,31.2% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,33.84,24,,,percent of total billed charges,24% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,33.84,112.8,
IV INFUSION CONCUREN,890029,CDM,260,RC,96368,HCPCS,Outpatient,,,234,117,,62.85,26.86,,,percent of total billed charges,26.86% of total billed charges,175.5,75,,,percent of total billed charges,75% of total billed charges ,175.5,75,,,percent of total billed charges,75% of total billed charges ,56.16,24,,,percent of total billed charges,24% of total billed charges ,175.5,75,,,percent of total billed charges,75% of total billed charges ,175.5,75,,,percent of total billed charges,75% of total billed charges ,187.2,80,,,percent of total billed charges,80% of total billed charges ,56.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,117.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,175.5,75,,,percent of total billed charges,75% of total billed charges ,57.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,62.85,26.86,,,percent of total billed charges,26.86% of total billed charges,56.16,24,,,percent of total billed charges,24% of total billed charges ,73.01,31.2,,,percent of total billed charges,31.2% of total billed charges,187.2,80,,,percent of total billed charges,80% of total billed charges,56.16,24,,,percent of total billed charges,24% of total billed charges ,56.16,24,,,percent of total billed charges,24% of total billed charges ,56.16,187.2,
IV INFUSION STOPSTAR,890030,CDM,260,RC,96367,HCPCS,Outpatient,,,143,71.5,,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,114.4,80,,,percent of total billed charges,80% of total billed charges ,34.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,35.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,44.62,31.2,,,percent of total billed charges,31.2% of total billed charges,114.4,80,,,percent of total billed charges,80% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,114.4,
HYDRATION INITIAL HR,890031,CDM,260,RC,96360,HCPCS,Outpatient,,,281,140.5,,75.48,26.86,,,percent of total billed charges,26.86% of total billed charges,210.75,75,,,percent of total billed charges,75% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,67.44,24,,,percent of total billed charges,24% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,224.8,80,,,percent of total billed charges,80% of total billed charges ,68.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,141.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,68.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,75.48,26.86,,,percent of total billed charges,26.86% of total billed charges,67.44,24,,,percent of total billed charges,24% of total billed charges ,87.67,31.2,,,percent of total billed charges,31.2% of total billed charges,224.8,80,,,percent of total billed charges,80% of total billed charges,67.44,24,,,percent of total billed charges,24% of total billed charges ,67.44,24,,,percent of total billed charges,24% of total billed charges ,67.44,224.8,
HYDRATION ADD HOURS,890032,CDM,260,RC,96361,HCPCS,Outpatient,,,171,85.5,,45.93,26.86,,,percent of total billed charges,26.86% of total billed charges,128.25,75,,,percent of total billed charges,75% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,41.04,24,,,percent of total billed charges,24% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,136.8,80,,,percent of total billed charges,80% of total billed charges ,41.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,86.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,41.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,45.93,26.86,,,percent of total billed charges,26.86% of total billed charges,41.04,24,,,percent of total billed charges,24% of total billed charges ,53.35,31.2,,,percent of total billed charges,31.2% of total billed charges,136.8,80,,,percent of total billed charges,80% of total billed charges,41.04,24,,,percent of total billed charges,24% of total billed charges ,41.04,24,,,percent of total billed charges,24% of total billed charges ,41.04,136.8,
LACERATION RPR SIMPL,890033,CDM,260,RC,,,Outpatient,,,217.5,108.75,,58.42,26.86,,,percent of total billed charges,26.86% of total billed charges,163.13,75,,,percent of total billed charges,75% of total billed charges ,163.13,75,,,percent of total billed charges,75% of total billed charges ,52.2,24,,,percent of total billed charges,24% of total billed charges ,163.13,75,,,percent of total billed charges,75% of total billed charges ,163.13,75,,,percent of total billed charges,75% of total billed charges ,174,80,,,percent of total billed charges,80% of total billed charges ,52.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,109.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,163.13,75,,,percent of total billed charges,75% of total billed charges ,53.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,58.42,26.86,,,percent of total billed charges,26.86% of total billed charges,52.2,24,,,percent of total billed charges,24% of total billed charges ,67.86,31.2,,,percent of total billed charges,31.2% of total billed charges,174,80,,,percent of total billed charges,80% of total billed charges,52.2,24,,,percent of total billed charges,24% of total billed charges ,52.2,24,,,percent of total billed charges,24% of total billed charges ,52.2,174,
LACERATION RPR INTER,890034,CDM,761,RC,,,Outpatient,,,501.5,250.75,,134.7,26.86,,,percent of total billed charges,26.86% of total billed charges,376.13,75,,,percent of total billed charges,75% of total billed charges ,376.13,75,,,percent of total billed charges,75% of total billed charges ,120.36,24,,,percent of total billed charges,24% of total billed charges ,376.13,75,,,percent of total billed charges,75% of total billed charges ,376.13,75,,,percent of total billed charges,75% of total billed charges ,401.2,80,,,percent of total billed charges,80% of total billed charges ,121.56,24.24,,,percent of total billed charges,24.24% of total billed charges ,252.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,376.13,75,,,percent of total billed charges,75% of total billed charges ,122.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,134.7,26.86,,,percent of total billed charges,26.86% of total billed charges,120.36,24,,,percent of total billed charges,24% of total billed charges ,156.47,31.2,,,percent of total billed charges,31.2% of total billed charges,401.2,80,,,percent of total billed charges,80% of total billed charges,120.36,24,,,percent of total billed charges,24% of total billed charges ,120.36,24,,,percent of total billed charges,24% of total billed charges ,120.36,401.2,
LACERATION RPR COMPL,890035,CDM,761,RC,,,Outpatient,,,704.5,352.25,,189.23,26.86,,,percent of total billed charges,26.86% of total billed charges,528.38,75,,,percent of total billed charges,75% of total billed charges ,528.38,75,,,percent of total billed charges,75% of total billed charges ,169.08,24,,,percent of total billed charges,24% of total billed charges ,528.38,75,,,percent of total billed charges,75% of total billed charges ,528.38,75,,,percent of total billed charges,75% of total billed charges ,563.6,80,,,percent of total billed charges,80% of total billed charges ,170.77,24.24,,,percent of total billed charges,24.24% of total billed charges ,355.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,528.38,75,,,percent of total billed charges,75% of total billed charges ,172.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,189.23,26.86,,,percent of total billed charges,26.86% of total billed charges,169.08,24,,,percent of total billed charges,24% of total billed charges ,219.8,31.2,,,percent of total billed charges,31.2% of total billed charges,563.6,80,,,percent of total billed charges,80% of total billed charges,169.08,24,,,percent of total billed charges,24% of total billed charges ,169.08,24,,,percent of total billed charges,24% of total billed charges ,169.08,563.6,
PROCEDURE INTERMEDIA,890037,CDM,761,RC,,,Outpatient,,,601.5,300.75,,161.56,26.86,,,percent of total billed charges,26.86% of total billed charges,451.13,75,,,percent of total billed charges,75% of total billed charges ,451.13,75,,,percent of total billed charges,75% of total billed charges ,144.36,24,,,percent of total billed charges,24% of total billed charges ,451.13,75,,,percent of total billed charges,75% of total billed charges ,451.13,75,,,percent of total billed charges,75% of total billed charges ,481.2,80,,,percent of total billed charges,80% of total billed charges ,145.8,24.24,,,percent of total billed charges,24.24% of total billed charges ,303.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,451.13,75,,,percent of total billed charges,75% of total billed charges ,147.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,161.56,26.86,,,percent of total billed charges,26.86% of total billed charges,144.36,24,,,percent of total billed charges,24% of total billed charges ,187.67,31.2,,,percent of total billed charges,31.2% of total billed charges,481.2,80,,,percent of total billed charges,80% of total billed charges,144.36,24,,,percent of total billed charges,24% of total billed charges ,144.36,24,,,percent of total billed charges,24% of total billed charges ,144.36,481.2,
TOXOID VACCINE,890039,CDM,761,RC,90471,HCPCS,Outpatient,,,65,32.5,,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,52,80,,,percent of total billed charges,80% of total billed charges ,15.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,15.6,24,,,percent of total billed charges,24% of total billed charges ,20.28,31.2,,,percent of total billed charges,31.2% of total billed charges,52,80,,,percent of total billed charges,80% of total billed charges,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,52,
INFLUENZA  ADMINISTRTATION,890040,CDM,771,RC,G0008,HCPCS,Outpatient,,,65,32.5,,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,52,80,,,percent of total billed charges,80% of total billed charges ,15.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,15.6,24,,,percent of total billed charges,24% of total billed charges ,20.28,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,52,
RABIES VACCINE,890042,CDM,761,RC,90471,HCPCS,Outpatient,,,65,32.5,,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,52,80,,,percent of total billed charges,80% of total billed charges ,15.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,15.6,24,,,percent of total billed charges,24% of total billed charges ,20.28,31.2,,,percent of total billed charges,31.2% of total billed charges,52,80,,,percent of total billed charges,80% of total billed charges,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,52,
HYBRESIS ELECTRODES,890044,CDM,272,RC,,,Outpatient,,,22,11,,5.91,26.86,,,percent of total billed charges,26.86% of total billed charges,16.5,75,,,percent of total billed charges,75% of total billed charges ,16.5,75,,,percent of total billed charges,75% of total billed charges ,5.28,24,,,percent of total billed charges,24% of total billed charges ,16.5,75,,,percent of total billed charges,75% of total billed charges ,16.5,75,,,percent of total billed charges,75% of total billed charges ,17.6,80,,,percent of total billed charges,80% of total billed charges ,5.33,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.5,75,,,percent of total billed charges,75% of total billed charges ,5.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.91,26.86,,,percent of total billed charges,26.86% of total billed charges,5.28,24,,,percent of total billed charges,24% of total billed charges ,6.86,31.2,,,percent of total billed charges,31.2% of total billed charges,17.6,80,,,percent of total billed charges,80% of total billed charges,5.28,24,,,percent of total billed charges,24% of total billed charges ,5.28,24,,,percent of total billed charges,24% of total billed charges ,5.28,17.6,
ALLERGAN NATRELLE BREAST IMPLANTS,890045,CDM,278,RC,L8600,HCPCS,Outpatient,,,2688,1344,,722,26.86,,,percent of total billed charges,26.86% of total billed charges,2016,75,,,percent of total billed charges,75% of total billed charges ,2016,75,,,percent of total billed charges,75% of total billed charges ,645.12,24,,,percent of total billed charges,24% of total billed charges ,2016,75,,,percent of total billed charges,75% of total billed charges ,2016,75,,,percent of total billed charges,75% of total billed charges ,2150.4,80,,,percent of total billed charges,80% of total billed charges ,651.57,24.24,,,percent of total billed charges,24.24% of total billed charges ,1354.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,2016,75,,,percent of total billed charges,75% of total billed charges ,658.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,722,26.86,,,percent of total billed charges,26.86% of total billed charges,645.12,24,,,percent of total billed charges,24% of total billed charges ,838.66,31.2,,,percent of total billed charges,31.2% of total billed charges,2150.4,80,,,percent of total billed charges,80% of total billed charges,645.12,24,,,percent of total billed charges,24% of total billed charges ,645.12,24,,,percent of total billed charges,24% of total billed charges ,645.12,2150.4,
BAMLANIVIMAB INFUSION/MONITORING,890100,CDM,771,RC,M0245,HCPCS,Outpatient,,,636.5,318.25,,170.96,26.86,,,percent of total billed charges,26.86% of total billed charges,477.38,75,,,percent of total billed charges,75% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,152.76,24,,,percent of total billed charges,24% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,509.2,80,,,percent of total billed charges,80% of total billed charges ,154.29,24.24,,,percent of total billed charges,24.24% of total billed charges ,320.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,155.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,170.96,26.86,,,percent of total billed charges,26.86% of total billed charges,152.76,24,,,percent of total billed charges,24% of total billed charges ,198.59,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,152.76,24,,,percent of total billed charges,24% of total billed charges ,152.76,24,,,percent of total billed charges,24% of total billed charges ,152.76,509.2,
BAM/ETESEVIMAB INFUSION/MONITORING,890101,CDM,771,RC,M0245,HCPCS,Outpatient,,,636.5,318.25,,170.96,26.86,,,percent of total billed charges,26.86% of total billed charges,477.38,75,,,percent of total billed charges,75% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,152.76,24,,,percent of total billed charges,24% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,509.2,80,,,percent of total billed charges,80% of total billed charges ,154.29,24.24,,,percent of total billed charges,24.24% of total billed charges ,320.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,155.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,170.96,26.86,,,percent of total billed charges,26.86% of total billed charges,152.76,24,,,percent of total billed charges,24% of total billed charges ,198.59,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,152.76,24,,,percent of total billed charges,24% of total billed charges ,152.76,24,,,percent of total billed charges,24% of total billed charges ,152.76,509.2,
REGENERON INFUSION/INJECTION MONITORING,890102,CDM,771,RC,M0243,HCPCS,Outpatient,,,636.5,318.25,,170.96,26.86,,,percent of total billed charges,26.86% of total billed charges,477.38,75,,,percent of total billed charges,75% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,152.76,24,,,percent of total billed charges,24% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,509.2,80,,,percent of total billed charges,80% of total billed charges ,154.29,24.24,,,percent of total billed charges,24.24% of total billed charges ,320.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,155.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,170.96,26.86,,,percent of total billed charges,26.86% of total billed charges,152.76,24,,,percent of total billed charges,24% of total billed charges ,198.59,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,152.76,24,,,percent of total billed charges,24% of total billed charges ,152.76,24,,,percent of total billed charges,24% of total billed charges ,152.76,509.2,
SOTROVIMAB INFUSION/INJECTION MONITORING,890103,CDM,771,RC,M0247,HCPCS,Outpatient,,,636.5,318.25,,170.96,26.86,,,percent of total billed charges,26.86% of total billed charges,477.38,75,,,percent of total billed charges,75% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,152.76,24,,,percent of total billed charges,24% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,509.2,80,,,percent of total billed charges,80% of total billed charges ,154.29,24.24,,,percent of total billed charges,24.24% of total billed charges ,320.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,155.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,170.96,26.86,,,percent of total billed charges,26.86% of total billed charges,152.76,24,,,percent of total billed charges,24% of total billed charges ,198.59,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,152.76,24,,,percent of total billed charges,24% of total billed charges ,152.76,24,,,percent of total billed charges,24% of total billed charges ,152.76,509.2,
..ZZ TEST TSH QUEST,919191,CDM,301,RC,82085,HCPCS,Outpatient,,,119.5,59.75,,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,12.2,95.6,
..ZZ TEST CMP QUEST,919192,CDM,301,RC,82085,HCPCS,Outpatient,,,119.5,59.75,,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,12.2,95.6,
..ZZ TEST SALMONELLA SHIGELLA,919193,CDM,301,RC,82085,HCPCS,Outpatient,,,119.5,59.75,,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,12.2,95.6,
..ZZ TEST CULTURE BLOOD,919194,CDM,301,RC,82085,HCPCS,Outpatient,,,119.5,59.75,,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,12.2,95.6,
..ZZ TEST HSV QUEST,919195,CDM,301,RC,82085,HCPCS,Outpatient,,,119.5,59.75,,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,12.2,95.6,
..ZZ TEST PTH INTACT QUEST,919196,CDM,301,RC,82085,HCPCS,Outpatient,,,119.5,59.75,,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,12.2,95.6,
..ZZ TEST VITAMIN D QUEST,919197,CDM,301,RC,82085,HCPCS,Outpatient,,,119.5,59.75,,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,12.2,95.6,
..ZZ TEST CULTURE AEROBIC GS,919199,CDM,301,RC,82085,HCPCS,Outpatient,,,119.5,59.75,,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,12.2,95.6,
GROUP THERAPY 1 HOUR,920019,CDM,915,RC,90853,HCPCS,Outpatient,,,257.5,128.75,,69.16,26.86,,,percent of total billed charges,26.86% of total billed charges,193.13,75,,,percent of total billed charges,75% of total billed charges ,193.13,75,,,percent of total billed charges,75% of total billed charges ,61.8,24,,,percent of total billed charges,24% of total billed charges ,193.13,75,,,percent of total billed charges,75% of total billed charges ,193.13,75,,,percent of total billed charges,75% of total billed charges ,206,80,,,percent of total billed charges,80% of total billed charges ,62.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,129.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,193.13,75,,,percent of total billed charges,75% of total billed charges ,63.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,69.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.8,24,,,percent of total billed charges,24% of total billed charges ,80.34,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,61.8,24,,,percent of total billed charges,24% of total billed charges ,61.8,24,,,percent of total billed charges,24% of total billed charges ,61.8,206,
INDIVIDUAL THERAPY 20-30 MIN,920020,CDM,914,RC,90832,HCPCS,Outpatient,,,99,49.5,,26.59,26.86,,,percent of total billed charges,26.86% of total billed charges,74.25,75,,,percent of total billed charges,75% of total billed charges ,74.25,75,,,percent of total billed charges,75% of total billed charges ,23.76,24,,,percent of total billed charges,24% of total billed charges ,74.25,75,,,percent of total billed charges,75% of total billed charges ,74.25,75,,,percent of total billed charges,75% of total billed charges ,79.2,80,,,percent of total billed charges,80% of total billed charges ,24,24.24,,,percent of total billed charges,24.24% of total billed charges ,49.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,74.25,75,,,percent of total billed charges,75% of total billed charges ,24.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.59,26.86,,,percent of total billed charges,26.86% of total billed charges,23.76,24,,,percent of total billed charges,24% of total billed charges ,30.89,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,23.76,24,,,percent of total billed charges,24% of total billed charges ,23.76,24,,,percent of total billed charges,24% of total billed charges ,23.76,79.2,
INDIVIDUAL THERAPY 45-50 MIN,920021,CDM,914,RC,90834,HCPCS,Outpatient,,,186.5,93.25,,50.09,26.86,,,percent of total billed charges,26.86% of total billed charges,139.88,75,,,percent of total billed charges,75% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,44.76,24,,,percent of total billed charges,24% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,149.2,80,,,percent of total billed charges,80% of total billed charges ,45.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,94,50.4,,,percent of total billed charges,50.4% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,45.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,50.09,26.86,,,percent of total billed charges,26.86% of total billed charges,44.76,24,,,percent of total billed charges,24% of total billed charges ,58.19,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,44.76,24,,,percent of total billed charges,24% of total billed charges ,44.76,24,,,percent of total billed charges,24% of total billed charges ,44.76,149.2,
INDIVIDUAL THERAPY 75-80 MIN,920022,CDM,914,RC,90837,HCPCS,Outpatient,,,375,187.5,,100.73,26.86,,,percent of total billed charges,26.86% of total billed charges,281.25,75,,,percent of total billed charges,75% of total billed charges ,281.25,75,,,percent of total billed charges,75% of total billed charges ,90,24,,,percent of total billed charges,24% of total billed charges ,281.25,75,,,percent of total billed charges,75% of total billed charges ,281.25,75,,,percent of total billed charges,75% of total billed charges ,300,80,,,percent of total billed charges,80% of total billed charges ,90.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,189,50.4,,,percent of total billed charges,50.4% of total billed charges ,281.25,75,,,percent of total billed charges,75% of total billed charges ,91.8,24.48,,,percent of total billed charges,24.48% of total billed charges ,100.73,26.86,,,percent of total billed charges,26.86% of total billed charges,90,24,,,percent of total billed charges,24% of total billed charges ,117,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,90,24,,,percent of total billed charges,24% of total billed charges ,90,24,,,percent of total billed charges,24% of total billed charges ,90,300,
FAMILY THERAPY W/O PT 1 HR,920023,CDM,916,RC,90846,HCPCS,Outpatient,,,186.5,93.25,,50.09,26.86,,,percent of total billed charges,26.86% of total billed charges,139.88,75,,,percent of total billed charges,75% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,44.76,24,,,percent of total billed charges,24% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,149.2,80,,,percent of total billed charges,80% of total billed charges ,45.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,94,50.4,,,percent of total billed charges,50.4% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,45.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,50.09,26.86,,,percent of total billed charges,26.86% of total billed charges,44.76,24,,,percent of total billed charges,24% of total billed charges ,58.19,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,44.76,24,,,percent of total billed charges,24% of total billed charges ,44.76,24,,,percent of total billed charges,24% of total billed charges ,44.76,149.2,
FAMILY THERAPY W PT 1HR,920024,CDM,916,RC,90847,HCPCS,Outpatient,,,186.5,93.25,,50.09,26.86,,,percent of total billed charges,26.86% of total billed charges,139.88,75,,,percent of total billed charges,75% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,44.76,24,,,percent of total billed charges,24% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,149.2,80,,,percent of total billed charges,80% of total billed charges ,45.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,94,50.4,,,percent of total billed charges,50.4% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,45.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,50.09,26.86,,,percent of total billed charges,26.86% of total billed charges,44.76,24,,,percent of total billed charges,24% of total billed charges ,58.19,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,44.76,24,,,percent of total billed charges,24% of total billed charges ,44.76,24,,,percent of total billed charges,24% of total billed charges ,44.76,149.2,
EVALUATION/ASSESSMENT FACILITY FEE,920025,CDM,900,RC,90791,HCPCS,Outpatient,,,367.5,183.75,,98.71,26.86,,,percent of total billed charges,26.86% of total billed charges,275.63,75,,,percent of total billed charges,75% of total billed charges ,275.63,75,,,percent of total billed charges,75% of total billed charges ,88.2,24,,,percent of total billed charges,24% of total billed charges ,275.63,75,,,percent of total billed charges,75% of total billed charges ,275.63,75,,,percent of total billed charges,75% of total billed charges ,294,80,,,percent of total billed charges,80% of total billed charges ,89.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,185.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,275.63,75,,,percent of total billed charges,75% of total billed charges ,89.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,98.71,26.86,,,percent of total billed charges,26.86% of total billed charges,88.2,24,,,percent of total billed charges,24% of total billed charges ,114.66,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,88.2,24,,,percent of total billed charges,24% of total billed charges ,88.2,24,,,percent of total billed charges,24% of total billed charges ,88.2,294,
EVAL/ASSESSMENT FACILITY FEE (W/MEDICAL,920026,CDM,900,RC,90792,HCPCS,Outpatient,,,424.5,212.25,,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,339.6,80,,,percent of total billed charges,80% of total billed charges ,102.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,213.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,103.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,132.44,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,339.6,
FACILITY FEE MD,920027,CDM,914,RC,G0463,HCPCS,Outpatient,,,318.5,159.25,,85.55,26.86,,,percent of total billed charges,26.86% of total billed charges,238.88,75,,,percent of total billed charges,75% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,76.44,24,,,percent of total billed charges,24% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,254.8,80,,,percent of total billed charges,80% of total billed charges ,77.2,24.24,,,percent of total billed charges,24.24% of total billed charges ,160.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,77.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,85.55,26.86,,,percent of total billed charges,26.86% of total billed charges,76.44,24,,,percent of total billed charges,24% of total billed charges ,99.37,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,76.44,24,,,percent of total billed charges,24% of total billed charges ,76.44,24,,,percent of total billed charges,24% of total billed charges ,76.44,254.8,
FOLLOW UP 5 MINUTES,920030,CDM,914,RC,99211,HCPCS,Outpatient,,,159.5,79.75,,42.84,26.86,,,percent of total billed charges,26.86% of total billed charges,119.63,75,,,percent of total billed charges,75% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,38.28,24,,,percent of total billed charges,24% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,127.6,80,,,percent of total billed charges,80% of total billed charges ,38.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,80.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,39.05,24.48,,,percent of total billed charges,24.48% of total billed charges ,42.84,26.86,,,percent of total billed charges,26.86% of total billed charges,38.28,24,,,percent of total billed charges,24% of total billed charges ,49.76,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,38.28,24,,,percent of total billed charges,24% of total billed charges ,38.28,24,,,percent of total billed charges,24% of total billed charges ,38.28,127.6,
IV PUSH INITIAL DRUG,1350007,CDM,260,RC,96374,HCPCS,Outpatient,,,245,122.5,,65.81,26.86,,,percent of total billed charges,26.86% of total billed charges,183.75,75,,,percent of total billed charges,75% of total billed charges ,183.75,75,,,percent of total billed charges,75% of total billed charges ,58.8,24,,,percent of total billed charges,24% of total billed charges ,183.75,75,,,percent of total billed charges,75% of total billed charges ,183.75,75,,,percent of total billed charges,75% of total billed charges ,196,80,,,percent of total billed charges,80% of total billed charges ,59.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,123.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,183.75,75,,,percent of total billed charges,75% of total billed charges ,59.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,65.81,26.86,,,percent of total billed charges,26.86% of total billed charges,58.8,24,,,percent of total billed charges,24% of total billed charges ,76.44,31.2,,,percent of total billed charges,31.2% of total billed charges,196,80,,,percent of total billed charges,80% of total billed charges,58.8,24,,,percent of total billed charges,24% of total billed charges ,58.8,24,,,percent of total billed charges,24% of total billed charges ,58.8,196,
IV PUSH EA ADDTL NEW DRUG,1350008,CDM,260,RC,96375,HCPCS,Outpatient,,,141,70.5,,37.87,26.86,,,percent of total billed charges,26.86% of total billed charges,105.75,75,,,percent of total billed charges,75% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,112.8,80,,,percent of total billed charges,80% of total billed charges ,34.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,71.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,34.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.87,26.86,,,percent of total billed charges,26.86% of total billed charges,33.84,24,,,percent of total billed charges,24% of total billed charges ,43.99,31.2,,,percent of total billed charges,31.2% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,33.84,24,,,percent of total billed charges,24% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,33.84,112.8,
IV PUSH EA ADDTL SAME DRUG,1350009,CDM,260,RC,96376,HCPCS,Outpatient,,,210,105,,56.41,26.86,,,percent of total billed charges,26.86% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,50.4,24,,,percent of total billed charges,24% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,168,80,,,percent of total billed charges,80% of total billed charges ,50.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,105.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,51.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,56.41,26.86,,,percent of total billed charges,26.86% of total billed charges,50.4,24,,,percent of total billed charges,24% of total billed charges ,65.52,31.2,,,percent of total billed charges,31.2% of total billed charges,168,80,,,percent of total billed charges,80% of total billed charges,50.4,24,,,percent of total billed charges,24% of total billed charges ,50.4,24,,,percent of total billed charges,24% of total billed charges ,50.4,168,
IV HYDRATION EA ADDTL HOUR,1350011,CDM,260,RC,96361,HCPCS,Outpatient,,,171,85.5,,45.93,26.86,,,percent of total billed charges,26.86% of total billed charges,128.25,75,,,percent of total billed charges,75% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,41.04,24,,,percent of total billed charges,24% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,136.8,80,,,percent of total billed charges,80% of total billed charges ,41.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,86.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,41.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,45.93,26.86,,,percent of total billed charges,26.86% of total billed charges,41.04,24,,,percent of total billed charges,24% of total billed charges ,53.35,31.2,,,percent of total billed charges,31.2% of total billed charges,136.8,80,,,percent of total billed charges,80% of total billed charges,41.04,24,,,percent of total billed charges,24% of total billed charges ,41.04,24,,,percent of total billed charges,24% of total billed charges ,41.04,136.8,
SIMPLE PROCEDURE,1350030,CDM,761,RC,,,Outpatient,,,195.5,97.75,,52.51,26.86,,,percent of total billed charges,26.86% of total billed charges,146.63,75,,,percent of total billed charges,75% of total billed charges ,146.63,75,,,percent of total billed charges,75% of total billed charges ,46.92,24,,,percent of total billed charges,24% of total billed charges ,146.63,75,,,percent of total billed charges,75% of total billed charges ,146.63,75,,,percent of total billed charges,75% of total billed charges ,156.4,80,,,percent of total billed charges,80% of total billed charges ,47.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,98.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,146.63,75,,,percent of total billed charges,75% of total billed charges ,47.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,52.51,26.86,,,percent of total billed charges,26.86% of total billed charges,46.92,24,,,percent of total billed charges,24% of total billed charges ,61,31.2,,,percent of total billed charges,31.2% of total billed charges,156.4,80,,,percent of total billed charges,80% of total billed charges,46.92,24,,,percent of total billed charges,24% of total billed charges ,46.92,24,,,percent of total billed charges,24% of total billed charges ,46.92,156.4,
ULTRASOUND GUIDANCE FOR VASCULAR ACCESS,1350031,CDM,402,RC,76937,HCPCS,Outpatient,,,274,137,,73.6,26.86,,,percent of total billed charges,26.86% of total billed charges,205.5,75,,,percent of total billed charges,75% of total billed charges ,205.5,75,,,percent of total billed charges,75% of total billed charges ,65.76,24,,,percent of total billed charges,24% of total billed charges ,205.5,75,,,percent of total billed charges,75% of total billed charges ,205.5,75,,,percent of total billed charges,75% of total billed charges ,219.2,80,,,percent of total billed charges,80% of total billed charges ,66.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,138.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,205.5,75,,,percent of total billed charges,75% of total billed charges ,67.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.6,26.86,,,percent of total billed charges,26.86% of total billed charges,65.76,24,,,percent of total billed charges,24% of total billed charges ,85.49,31.2,,,percent of total billed charges,31.2% of total billed charges,219.2,80,,,percent of total billed charges,80% of total billed charges,65.76,24,,,percent of total billed charges,24% of total billed charges ,65.76,24,,,percent of total billed charges,24% of total billed charges ,65.76,219.2,
IV INFUSION ADDL SEQ INFUSION UP TO 1 HO,1350033,CDM,260,RC,96367,HCPCS,Outpatient,,,143,71.5,,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,114.4,80,,,percent of total billed charges,80% of total billed charges ,34.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,35.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,44.62,31.2,,,percent of total billed charges,31.2% of total billed charges,114.4,80,,,percent of total billed charges,80% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,114.4,
BAMLANIMIVAB INFUSION/MONITORING,1350100,CDM,771,RC,M0245,HCPCS,Outpatient,,,636.5,318.25,,170.96,26.86,,,percent of total billed charges,26.86% of total billed charges,477.38,75,,,percent of total billed charges,75% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,152.76,24,,,percent of total billed charges,24% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,509.2,80,,,percent of total billed charges,80% of total billed charges ,154.29,24.24,,,percent of total billed charges,24.24% of total billed charges ,320.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,155.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,170.96,26.86,,,percent of total billed charges,26.86% of total billed charges,152.76,24,,,percent of total billed charges,24% of total billed charges ,198.59,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,152.76,24,,,percent of total billed charges,24% of total billed charges ,152.76,24,,,percent of total billed charges,24% of total billed charges ,152.76,509.2,
BAM/ETESEVIMAB INFUSION/MONITORING,1350101,CDM,771,RC,M0245,HCPCS,Outpatient,,,636.5,318.25,,170.96,26.86,,,percent of total billed charges,26.86% of total billed charges,477.38,75,,,percent of total billed charges,75% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,152.76,24,,,percent of total billed charges,24% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,509.2,80,,,percent of total billed charges,80% of total billed charges ,154.29,24.24,,,percent of total billed charges,24.24% of total billed charges ,320.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,155.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,170.96,26.86,,,percent of total billed charges,26.86% of total billed charges,152.76,24,,,percent of total billed charges,24% of total billed charges ,198.59,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,152.76,24,,,percent of total billed charges,24% of total billed charges ,152.76,24,,,percent of total billed charges,24% of total billed charges ,152.76,509.2,
PAP SMEAR OBTAINING PREPARING AND CONVEY,1400091,CDM,521,RC,Q0091,HCPCS,Outpatient,,,145,72.5,,38.95,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,116,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,73.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,108.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,38.95,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,38.95,241.16,
INFLUENZA VACCINE 3 YEARS AND OLDER,1402038,CDM,521,RC,Q2038,HCPCS,Outpatient,,,36,18,,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,28.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,18.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,9.67,241.16,
INFLUENZA ADMINISTRATION (MEDICARE ONLY),1410008,CDM,521,RC,G0008,HCPCS,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,7.25,241.16,
ADMIN PNEUMOCOCCAL VACCINE (MEDICARE),1410009,CDM,521,RC,G0009,HCPCS,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,7.25,241.16,
I&D COMPLICATED OR MULTIPLE,1410061,CDM,521,RC,10061,HCPCS,Outpatient,,,555,277.5,,149.07,26.86,,,percent of total billed charges,26.86% of total billed charges,416.25,75,,,percent of total billed charges,75% of total billed charges ,416.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,416.25,75,,,percent of total billed charges,75% of total billed charges ,416.25,75,,,percent of total billed charges,75% of total billed charges ,444,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,279.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,416.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,149.07,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,149.07,444,
I & D OF PILONIDAL CYST SIMPLE,1410080,CDM,521,RC,10080,HCPCS,Outpatient,,,367.5,183.75,,98.71,26.86,,,percent of total billed charges,26.86% of total billed charges,275.63,75,,,percent of total billed charges,75% of total billed charges ,275.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,275.63,75,,,percent of total billed charges,75% of total billed charges ,275.63,75,,,percent of total billed charges,75% of total billed charges ,294,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,185.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,275.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,98.71,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,98.71,294,
I & D OF PILONIDAL CYST COMPLICATED,1410081,CDM,521,RC,10081,HCPCS,Outpatient,,,657,328.5,,176.47,26.86,,,percent of total billed charges,26.86% of total billed charges,492.75,75,,,percent of total billed charges,75% of total billed charges ,492.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,492.75,75,,,percent of total billed charges,75% of total billed charges ,492.75,75,,,percent of total billed charges,75% of total billed charges ,525.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,331.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,492.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,176.47,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,176.47,525.6,
CERVICAL OR VAGINAL CANCER SCRENING,1410101,CDM,521,RC,G0101,HCPCS,Outpatient,,,126.5,63.25,,33.98,26.86,,,percent of total billed charges,26.86% of total billed charges,94.88,75,,,percent of total billed charges,75% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,94.88,75,,,percent of total billed charges,75% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,101.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,63.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,33.98,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,33.98,241.16,
SCREENING FLEX SIGMOIDOSCOPY,1410104,CDM,360,RC,G0104,HCPCS,Outpatient,,,402.5,201.25,,108.11,26.86,,,percent of total billed charges,26.86% of total billed charges,301.88,75,,,percent of total billed charges,75% of total billed charges ,301.88,75,,,percent of total billed charges,75% of total billed charges ,96.6,24,,,percent of total billed charges,24% of total billed charges ,301.88,75,,,percent of total billed charges,75% of total billed charges ,301.88,75,,,percent of total billed charges,75% of total billed charges ,322,80,,,percent of total billed charges,80% of total billed charges ,97.57,24.24,,,percent of total billed charges,24.24% of total billed charges ,202.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,301.88,75,,,percent of total billed charges,75% of total billed charges ,98.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,108.11,26.86,,,percent of total billed charges,26.86% of total billed charges,96.6,24,,,percent of total billed charges,24% of total billed charges ,125.58,31.2,,,percent of total billed charges,31.2% of total billed charges,322,80,,,percent of total billed charges,80% of total billed charges,96.6,24,,,percent of total billed charges,24% of total billed charges ,96.6,24,,,percent of total billed charges,24% of total billed charges ,96.6,322,
SCREENING COLONOSCOPY/HIGH RISK,1410105,CDM,360,RC,G0105,HCPCS,Outpatient,,,1279.5,639.75,,343.67,26.86,,,percent of total billed charges,26.86% of total billed charges,959.63,75,,,percent of total billed charges,75% of total billed charges ,959.63,75,,,percent of total billed charges,75% of total billed charges ,307.08,24,,,percent of total billed charges,24% of total billed charges ,959.63,75,,,percent of total billed charges,75% of total billed charges ,959.63,75,,,percent of total billed charges,75% of total billed charges ,1023.6,80,,,percent of total billed charges,80% of total billed charges ,310.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,644.87,50.4,,,percent of total billed charges,50.4% of total billed charges ,959.63,75,,,percent of total billed charges,75% of total billed charges ,313.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,343.67,26.86,,,percent of total billed charges,26.86% of total billed charges,307.08,24,,,percent of total billed charges,24% of total billed charges ,399.2,31.2,,,percent of total billed charges,31.2% of total billed charges,1023.6,80,,,percent of total billed charges,80% of total billed charges,307.08,24,,,percent of total billed charges,24% of total billed charges ,307.08,24,,,percent of total billed charges,24% of total billed charges ,307.08,1023.6,
INCISION AND REMOVAL OF FOREIGN BODY SIM,1410120,CDM,521,RC,10120,HCPCS,Outpatient,,,329.5,164.75,,88.5,26.86,,,percent of total billed charges,26.86% of total billed charges,247.13,75,,,percent of total billed charges,75% of total billed charges ,247.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,247.13,75,,,percent of total billed charges,75% of total billed charges ,247.13,75,,,percent of total billed charges,75% of total billed charges ,263.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,166.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,247.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,88.5,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,88.5,263.6,
INCISION AND REMOVAL OF FOREIGN BODY COM,1410121,CDM,521,RC,10121,HCPCS,Outpatient,,,755,377.5,,202.79,26.86,,,percent of total billed charges,26.86% of total billed charges,566.25,75,,,percent of total billed charges,75% of total billed charges ,566.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,566.25,75,,,percent of total billed charges,75% of total billed charges ,566.25,75,,,percent of total billed charges,75% of total billed charges ,604,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,380.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,566.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,202.79,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,604,
COLORECTAL CANCER SCREENING COLONOSCOPY,1410122,CDM,360,RC,G0121,HCPCS,Outpatient,,,1172,586,,314.8,26.86,,,percent of total billed charges,26.86% of total billed charges,879,75,,,percent of total billed charges,75% of total billed charges ,879,75,,,percent of total billed charges,75% of total billed charges ,281.28,24,,,percent of total billed charges,24% of total billed charges ,879,75,,,percent of total billed charges,75% of total billed charges ,879,75,,,percent of total billed charges,75% of total billed charges ,937.6,80,,,percent of total billed charges,80% of total billed charges ,284.09,24.24,,,percent of total billed charges,24.24% of total billed charges ,590.69,50.4,,,percent of total billed charges,50.4% of total billed charges ,879,75,,,percent of total billed charges,75% of total billed charges ,286.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,314.8,26.86,,,percent of total billed charges,26.86% of total billed charges,281.28,24,,,percent of total billed charges,24% of total billed charges ,365.66,31.2,,,percent of total billed charges,31.2% of total billed charges,937.6,80,,,percent of total billed charges,80% of total billed charges,281.28,24,,,percent of total billed charges,24% of total billed charges ,281.28,24,,,percent of total billed charges,24% of total billed charges ,281.28,937.6,
I & D OF HEMATOMA SEROMA OR FLUID COLLEC,1410140,CDM,521,RC,10140,HCPCS,Outpatient,,,355.5,177.75,,95.49,26.86,,,percent of total billed charges,26.86% of total billed charges,266.63,75,,,percent of total billed charges,75% of total billed charges ,266.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,266.63,75,,,percent of total billed charges,75% of total billed charges ,266.63,75,,,percent of total billed charges,75% of total billed charges ,284.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,179.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,266.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,95.49,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,95.49,284.4,
PUNCTURE ASPIRATION OF ABSCESS HEMATOMA,1410160,CDM,521,RC,10160,HCPCS,Outpatient,,,246,123,,66.08,26.86,,,percent of total billed charges,26.86% of total billed charges,184.5,75,,,percent of total billed charges,75% of total billed charges ,184.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,184.5,75,,,percent of total billed charges,75% of total billed charges ,184.5,75,,,percent of total billed charges,75% of total billed charges ,196.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,123.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,184.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,66.08,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,66.08,241.16,
PHYSICIAN RECERTIFICATION FOR MEDICARE,1410179,CDM,521,RC,G0179,HCPCS,Outpatient,,,121.5,60.75,,32.63,26.86,,,percent of total billed charges,26.86% of total billed charges,91.13,75,,,percent of total billed charges,75% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,91.13,75,,,percent of total billed charges,75% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,97.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,61.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,32.63,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,32.63,241.16,
I & D COMPLEX POST OP WOUND INFECTION,1410180,CDM,521,RC,10180,HCPCS,Outpatient,,,628.5,314.25,,168.82,26.86,,,percent of total billed charges,26.86% of total billed charges,471.38,75,,,percent of total billed charges,75% of total billed charges ,471.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,471.38,75,,,percent of total billed charges,75% of total billed charges ,471.38,75,,,percent of total billed charges,75% of total billed charges ,502.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,316.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,471.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,168.82,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,168.82,502.8,
PHYSICIAN CERTIFICATION FOR MEDICARE,1410181,CDM,521,RC,G0180,HCPCS,Outpatient,,,161.5,80.75,,43.38,26.86,,,percent of total billed charges,26.86% of total billed charges,121.13,75,,,percent of total billed charges,75% of total billed charges ,121.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,121.13,75,,,percent of total billed charges,75% of total billed charges ,121.13,75,,,percent of total billed charges,75% of total billed charges ,129.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,81.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,121.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,43.38,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,43.38,241.16,
COLORECTAL SCREENING WELCOME TO MEDICARE,1410328,CDM,360,RC,G0328,HCPCS,Outpatient,,,84.5,42.25,,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.38,75,,,percent of total billed charges,75% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,20.28,24,,,percent of total billed charges,24% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,67.6,80,,,percent of total billed charges,80% of total billed charges ,20.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,20.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.28,24,,,percent of total billed charges,24% of total billed charges ,26.36,31.2,,,percent of total billed charges,31.2% of total billed charges,67.6,80,,,percent of total billed charges,80% of total billed charges,20.28,24,,,percent of total billed charges,24% of total billed charges ,20.28,24,,,percent of total billed charges,24% of total billed charges ,16.28,67.6,
INITIAL PREVENTATIVE PHYSICAL WELCOME TO,1410402,CDM,521,RC,G0402,HCPCS,Outpatient,,,423.5,211.75,,113.75,26.86,,,percent of total billed charges,26.86% of total billed charges,317.63,75,,,percent of total billed charges,75% of total billed charges ,317.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,317.63,75,,,percent of total billed charges,75% of total billed charges ,317.63,75,,,percent of total billed charges,75% of total billed charges ,338.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,213.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,317.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,113.75,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,113.75,338.8,
EKG WELCOME TO MEDICARE PHYSICAL,1410403,CDM,521,RC,G0403,HCPCS,Outpatient,,,61,30.5,,16.38,26.86,,,percent of total billed charges,26.86% of total billed charges,45.75,75,,,percent of total billed charges,75% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,45.75,75,,,percent of total billed charges,75% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,48.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,30.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,16.38,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,16.38,241.16,
EKG ROUNTINE INTERPRET/REPORT SCREENING,1410405,CDM,521,RC,G0405,HCPCS,Outpatient,,,61,30.5,,16.38,26.86,,,percent of total billed charges,26.86% of total billed charges,45.75,75,,,percent of total billed charges,75% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,45.75,75,,,percent of total billed charges,75% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,48.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,30.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,16.38,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,16.38,241.16,
SMOKING AND TOBACCO CESSATON,1410436,CDM,521,RC,99406,HCPCS,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,12.49,241.16,
ANNUAL WELLNESS VISIT INITIAL VISIT,1410438,CDM,521,RC,G0438,HCPCS,Outpatient,,,496.5,248.25,,133.36,26.86,,,percent of total billed charges,26.86% of total billed charges,372.38,75,,,percent of total billed charges,75% of total billed charges ,372.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,372.38,75,,,percent of total billed charges,75% of total billed charges ,372.38,75,,,percent of total billed charges,75% of total billed charges ,397.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,250.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,372.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,133.36,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,133.36,397.2,
DEBRIDEMENT OF EXTENSIVE EZCEMATOUS,1411000,CDM,521,RC,11000,HCPCS,Outpatient,,,212,106,,56.94,26.86,,,percent of total billed charges,26.86% of total billed charges,159,75,,,percent of total billed charges,75% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,159,75,,,percent of total billed charges,75% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,169.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,106.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,56.94,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,56.94,241.16,
DEBRIDEMENT SKIN-PARTIAL THICKNESS,1411040,CDM,521,RC,97597,HCPCS,Outpatient,,,159.5,79.75,,42.84,26.86,,,percent of total billed charges,26.86% of total billed charges,119.63,75,,,percent of total billed charges,75% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,119.63,75,,,percent of total billed charges,75% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,127.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,80.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,42.84,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,42.84,241.16,
DEBRIDEMENT SUBCUTANEOUS TISSUE FIRS 20,1411042,CDM,521,RC,11042,HCPCS,Outpatient,,,246,123,,66.08,26.86,,,percent of total billed charges,26.86% of total billed charges,184.5,75,,,percent of total billed charges,75% of total billed charges ,184.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,184.5,75,,,percent of total billed charges,75% of total billed charges ,184.5,75,,,percent of total billed charges,75% of total billed charges ,196.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,123.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,184.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,66.08,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,66.08,241.16,
DEBRIDEMENT MUSCLE AND/OR FASCIA FIRST 2,1411043,CDM,521,RC,11043,HCPCS,Outpatient,,,527.5,263.75,,141.69,26.86,,,percent of total billed charges,26.86% of total billed charges,395.63,75,,,percent of total billed charges,75% of total billed charges ,395.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,395.63,75,,,percent of total billed charges,75% of total billed charges ,395.63,75,,,percent of total billed charges,75% of total billed charges ,422,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,265.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,395.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,141.69,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,141.69,422,
DEBRIDEMENT BONE FIRS 20 SQ CM OR LESS,1411044,CDM,521,RC,11044,HCPCS,Outpatient,,,878.5,439.25,,235.97,26.86,,,percent of total billed charges,26.86% of total billed charges,658.88,75,,,percent of total billed charges,75% of total billed charges ,658.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,658.88,75,,,percent of total billed charges,75% of total billed charges ,658.88,75,,,percent of total billed charges,75% of total billed charges ,702.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,442.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,658.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,235.97,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,702.8,
PARING/CUTTING KERATOTIC LESION 1,1411055,CDM,521,RC,11055,HCPCS,Outpatient,,,107,53.5,,28.74,26.86,,,percent of total billed charges,26.86% of total billed charges,80.25,75,,,percent of total billed charges,75% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,80.25,75,,,percent of total billed charges,75% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,85.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,53.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,28.74,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,28.74,241.16,
PARING/CUTTING B9 KERATOTIC LES 2-4,1411056,CDM,521,RC,11056,HCPCS,Outpatient,,,134,67,,35.99,26.86,,,percent of total billed charges,26.86% of total billed charges,100.5,75,,,percent of total billed charges,75% of total billed charges ,100.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,100.5,75,,,percent of total billed charges,75% of total billed charges ,100.5,75,,,percent of total billed charges,75% of total billed charges ,107.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,67.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,100.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,35.99,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,35.99,241.16,
BIOPSY OF SKIN SUBQ TISSUE (INCLUDING SI,1411100,CDM,521,RC,11102,HCPCS,Outpatient,,,184.5,92.25,,49.56,26.86,,,percent of total billed charges,26.86% of total billed charges,138.38,75,,,percent of total billed charges,75% of total billed charges ,138.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,138.38,75,,,percent of total billed charges,75% of total billed charges ,138.38,75,,,percent of total billed charges,75% of total billed charges ,147.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,92.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,138.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,49.56,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,49.56,241.16,
BIOPSY OF SKIN SUBQ (INCLUDING SIMPLE CL,1411101,CDM,521,RC,11103,HCPCS,Outpatient,,,92.5,46.25,,24.85,26.86,,,percent of total billed charges,26.86% of total billed charges,69.38,75,,,percent of total billed charges,75% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,69.38,75,,,percent of total billed charges,75% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,74,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,46.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,24.85,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,24.85,241.16,
REMOVAL OF SKIN TAGS UP TO 15,1411200,CDM,521,RC,11200,HCPCS,Outpatient,,,171,85.5,,45.93,26.86,,,percent of total billed charges,26.86% of total billed charges,128.25,75,,,percent of total billed charges,75% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,128.25,75,,,percent of total billed charges,75% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,136.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,86.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,45.93,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,45.93,241.16,
SHAVING OF EPIDERMAL /DERMAL LESION SING,1411300,CDM,521,RC,11300,HCPCS,Outpatient,,,166,83,,44.59,26.86,,,percent of total billed charges,26.86% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,44.59,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,44.59,241.16,
SHAVING OF DERMAL LESION SINGLE TRUNK/AR,1411301,CDM,521,RC,11301,HCPCS,Outpatient,,,204,102,,54.79,26.86,,,percent of total billed charges,26.86% of total billed charges,153,75,,,percent of total billed charges,75% of total billed charges ,153,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,153,75,,,percent of total billed charges,75% of total billed charges ,153,75,,,percent of total billed charges,75% of total billed charges ,163.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,102.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,153,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,54.79,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,54.79,241.16,
EXC B9 LESION SCP SK TGS .5 CM<,1411400,CDM,521,RC,11400,HCPCS,Outpatient,,,253.5,126.75,,68.09,26.86,,,percent of total billed charges,26.86% of total billed charges,190.13,75,,,percent of total billed charges,75% of total billed charges ,190.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,190.13,75,,,percent of total billed charges,75% of total billed charges ,190.13,75,,,percent of total billed charges,75% of total billed charges ,202.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,127.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,190.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,68.09,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,68.09,241.16,
EXC BENIGN LESION TRUNK/ARMS/LESGS 0.6 T,1411401,CDM,521,RC,11401,HCPCS,Outpatient,,,303,151.5,,81.39,26.86,,,percent of total billed charges,26.86% of total billed charges,227.25,75,,,percent of total billed charges,75% of total billed charges ,227.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,227.25,75,,,percent of total billed charges,75% of total billed charges ,227.25,75,,,percent of total billed charges,75% of total billed charges ,242.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,152.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,227.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,81.39,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,81.39,242.4,
EXC B9 LES MRGN XCP SKT 1.1-2.0CM,1411402,CDM,521,RC,11402,HCPCS,Outpatient,,,386.5,193.25,,103.81,26.86,,,percent of total billed charges,26.86% of total billed charges,289.88,75,,,percent of total billed charges,75% of total billed charges ,289.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,289.88,75,,,percent of total billed charges,75% of total billed charges ,289.88,75,,,percent of total billed charges,75% of total billed charges ,309.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,194.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,289.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,103.81,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,103.81,309.2,
EXC B9 LESIO MRGN 2.1-3.0 CM,1411403,CDM,521,RC,11403,HCPCS,Outpatient,,,495.5,247.75,,133.09,26.86,,,percent of total billed charges,26.86% of total billed charges,371.63,75,,,percent of total billed charges,75% of total billed charges ,371.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,371.63,75,,,percent of total billed charges,75% of total billed charges ,371.63,75,,,percent of total billed charges,75% of total billed charges ,396.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,249.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,371.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,133.09,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,133.09,396.4,
EXC BENIGN LESION SCALP/NECK/HANDS/FEET/,1411422,CDM,521,RC,11422,HCPCS,Outpatient,,,411,205.5,,110.39,26.86,,,percent of total billed charges,26.86% of total billed charges,308.25,75,,,percent of total billed charges,75% of total billed charges ,308.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,308.25,75,,,percent of total billed charges,75% of total billed charges ,308.25,75,,,percent of total billed charges,75% of total billed charges ,328.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,207.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,308.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,110.39,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,110.39,328.8,
EXC OTHER BENIGN LESION INCL MARGINS .5,1411440,CDM,521,RC,11440,HCPCS,Outpatient,,,303,151.5,,81.39,26.86,,,percent of total billed charges,26.86% of total billed charges,227.25,75,,,percent of total billed charges,75% of total billed charges ,227.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,227.25,75,,,percent of total billed charges,75% of total billed charges ,227.25,75,,,percent of total billed charges,75% of total billed charges ,242.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,152.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,227.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,81.39,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,81.39,242.4,
EXC MALIGNANT LESION TRUNK/ARMS/LEGS .5,1411600,CDM,521,RC,11600,HCPCS,Outpatient,,,415,207.5,,111.47,26.86,,,percent of total billed charges,26.86% of total billed charges,311.25,75,,,percent of total billed charges,75% of total billed charges ,311.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,311.25,75,,,percent of total billed charges,75% of total billed charges ,311.25,75,,,percent of total billed charges,75% of total billed charges ,332,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,209.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,311.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,111.47,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,111.47,332,
EXC MAL LES W/MRGN T/A/L > 4.0 CM,1411606,CDM,521,RC,11606,HCPCS,Outpatient,,,904.5,452.25,,242.95,26.86,,,percent of total billed charges,26.86% of total billed charges,678.38,75,,,percent of total billed charges,75% of total billed charges ,678.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,678.38,75,,,percent of total billed charges,75% of total billed charges ,678.38,75,,,percent of total billed charges,75% of total billed charges ,723.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,455.87,50.4,,,percent of total billed charges,50.4% of total billed charges ,678.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,242.95,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,723.6,
EXC MALIGNANT LESION .5/CM,1411621,CDM,521,RC,11621,HCPCS,Outpatient,,,452,226,,121.41,26.86,,,percent of total billed charges,26.86% of total billed charges,339,75,,,percent of total billed charges,75% of total billed charges ,339,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,339,75,,,percent of total billed charges,75% of total billed charges ,339,75,,,percent of total billed charges,75% of total billed charges ,361.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,227.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,339,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,121.41,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,121.41,361.6,
EXC MALIGNANT LESION 2.1 TO 3.0 CM SCALP,1411623,CDM,521,RC,11623,HCPCS,Outpatient,,,677.5,338.75,,181.98,26.86,,,percent of total billed charges,26.86% of total billed charges,508.13,75,,,percent of total billed charges,75% of total billed charges ,508.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,508.13,75,,,percent of total billed charges,75% of total billed charges ,508.13,75,,,percent of total billed charges,75% of total billed charges ,542,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,341.46,50.4,,,percent of total billed charges,50.4% of total billed charges ,508.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,181.98,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,181.98,542,
DEBRIDEMENT OF NAIL 1 TO 5,1411720,CDM,521,RC,11720,HCPCS,Outpatient,,,98,49,,26.32,26.86,,,percent of total billed charges,26.86% of total billed charges,73.5,75,,,percent of total billed charges,75% of total billed charges ,73.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,73.5,75,,,percent of total billed charges,75% of total billed charges ,73.5,75,,,percent of total billed charges,75% of total billed charges ,78.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,49.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,73.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,26.32,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,26.32,241.16,
DEBRIDEMENT OF NAILS BY ANY METHOD 6 OR,1411721,CDM,521,RC,11721,HCPCS,Outpatient,,,133,66.5,,35.72,26.86,,,percent of total billed charges,26.86% of total billed charges,99.75,75,,,percent of total billed charges,75% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,99.75,75,,,percent of total billed charges,75% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,106.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,67.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,35.72,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,35.72,241.16,
NAIL AVULSION PARTIAL OR COMPLETE,1411730,CDM,521,RC,11730,HCPCS,Outpatient,,,352.5,176.25,,94.68,26.86,,,percent of total billed charges,26.86% of total billed charges,264.38,75,,,percent of total billed charges,75% of total billed charges ,264.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,264.38,75,,,percent of total billed charges,75% of total billed charges ,264.38,75,,,percent of total billed charges,75% of total billed charges ,282,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,177.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,264.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,94.68,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,94.68,282,
EVACUATION OF SUBUNGUAL HEMATOMA,1411740,CDM,521,RC,11740,HCPCS,Outpatient,,,162.5,81.25,,43.65,26.86,,,percent of total billed charges,26.86% of total billed charges,121.88,75,,,percent of total billed charges,75% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,121.88,75,,,percent of total billed charges,75% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,130,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,81.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,43.65,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,43.65,241.16,
EXCISION OF NAIL AND NAIL MATRIX PARTIAL,1411750,CDM,521,RC,11750,HCPCS,Outpatient,,,732.5,366.25,,196.75,26.86,,,percent of total billed charges,26.86% of total billed charges,549.38,75,,,percent of total billed charges,75% of total billed charges ,549.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,549.38,75,,,percent of total billed charges,75% of total billed charges ,549.38,75,,,percent of total billed charges,75% of total billed charges ,586,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,369.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,549.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,196.75,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,586,
WEDGE EXCOF SKIN NAIL FOLD (INGROWN TOEN,1411765,CDM,521,RC,11765,HCPCS,Outpatient,,,433.5,216.75,,116.44,26.86,,,percent of total billed charges,26.86% of total billed charges,325.13,75,,,percent of total billed charges,75% of total billed charges ,325.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,325.13,75,,,percent of total billed charges,75% of total billed charges ,325.13,75,,,percent of total billed charges,75% of total billed charges ,346.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,218.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,325.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,116.44,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,116.44,346.8,
EXCISION OF PILONIDAL CYST COMPLICATED,1411772,CDM,521,RC,11772,HCPCS,Outpatient,,,2146.5,1073.25,,576.55,26.86,,,percent of total billed charges,26.86% of total billed charges,1609.88,75,,,percent of total billed charges,75% of total billed charges ,1609.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1609.88,75,,,percent of total billed charges,75% of total billed charges ,1609.88,75,,,percent of total billed charges,75% of total billed charges ,1717.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1081.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,1609.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,576.55,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1717.2,
SIMPLE REPAIR SUPERFICIAL WOUND,1412001,CDM,521,RC,12001,HCPCS,Outpatient,,,478,239,,128.39,26.86,,,percent of total billed charges,26.86% of total billed charges,358.5,75,,,percent of total billed charges,75% of total billed charges ,358.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,358.5,75,,,percent of total billed charges,75% of total billed charges ,358.5,75,,,percent of total billed charges,75% of total billed charges ,382.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,240.91,50.4,,,percent of total billed charges,50.4% of total billed charges ,358.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,128.39,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,128.39,382.4,
SIMPLE REPAIR OF SUPERFICIAL WOUND 7.6 C,1412002,CDM,521,RC,12002,HCPCS,Outpatient,,,577,288.5,,154.98,26.86,,,percent of total billed charges,26.86% of total billed charges,432.75,75,,,percent of total billed charges,75% of total billed charges ,432.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,432.75,75,,,percent of total billed charges,75% of total billed charges ,432.75,75,,,percent of total billed charges,75% of total billed charges ,461.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,290.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,432.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,154.98,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,154.98,461.6,
COLONOSCOPY W/ BIOPSY,1413132,CDM,360,RC,13132,HCPCS,Outpatient,,,1688,844,,453.4,26.86,,,percent of total billed charges,26.86% of total billed charges,1266,75,,,percent of total billed charges,75% of total billed charges ,1266,75,,,percent of total billed charges,75% of total billed charges ,405.12,24,,,percent of total billed charges,24% of total billed charges ,1266,75,,,percent of total billed charges,75% of total billed charges ,1266,75,,,percent of total billed charges,75% of total billed charges ,1350.4,80,,,percent of total billed charges,80% of total billed charges ,409.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,850.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,1266,75,,,percent of total billed charges,75% of total billed charges ,413.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,453.4,26.86,,,percent of total billed charges,26.86% of total billed charges,405.12,24,,,percent of total billed charges,24% of total billed charges ,526.66,31.2,,,percent of total billed charges,31.2% of total billed charges,1350.4,80,,,percent of total billed charges,80% of total billed charges,405.12,24,,,percent of total billed charges,24% of total billed charges ,405.12,24,,,percent of total billed charges,24% of total billed charges ,405.12,1350.4,
ADVANCEMENT FLAPS TRUNK,1415734,CDM,521,RC,15734,HCPCS,Outpatient,,,6641.5,3320.75,,1783.91,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,5313.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,3347.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,4981.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,1783.91,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,5313.2,
DESTRUCTION PRMLGNT LESION (ACTINIC KERA,1417000,CDM,521,RC,17000,HCPCS,Outpatient,,,193.5,96.75,,51.97,26.86,,,percent of total billed charges,26.86% of total billed charges,145.13,75,,,percent of total billed charges,75% of total billed charges ,145.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,145.13,75,,,percent of total billed charges,75% of total billed charges ,145.13,75,,,percent of total billed charges,75% of total billed charges ,154.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,97.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,145.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,51.97,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,51.97,241.16,
DESTRUCTION PRMLGNT LESION 2-14 EACH,1417003,CDM,521,RC,17003,HCPCS,Outpatient,,,43.5,21.75,,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,34.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,21.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,11.68,241.16,
CHEMICAL CAUTERIZATION OF GRANULATION TI,1417250,CDM,521,RC,17250,HCPCS,Outpatient,,,140,70,,37.6,26.86,,,percent of total billed charges,26.86% of total billed charges,105,75,,,percent of total billed charges,75% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,105,75,,,percent of total billed charges,75% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,112,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,70.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,37.6,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,37.6,241.16,
DESTRUCTION MALIGNANT LESION < .5 CM,1417260,CDM,521,RC,17260,HCPCS,Outpatient,,,223.5,111.75,,60.03,26.86,,,percent of total billed charges,26.86% of total billed charges,167.63,75,,,percent of total billed charges,75% of total billed charges ,167.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,167.63,75,,,percent of total billed charges,75% of total billed charges ,167.63,75,,,percent of total billed charges,75% of total billed charges ,178.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,112.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,60.03,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,60.03,241.16,
DESTRUCTION MALIGNANT LESION TRUNK/ARMS/,1417263,CDM,521,RC,17263,HCPCS,Outpatient,,,331.5,165.75,,89.04,26.86,,,percent of total billed charges,26.86% of total billed charges,248.63,75,,,percent of total billed charges,75% of total billed charges ,248.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,248.63,75,,,percent of total billed charges,75% of total billed charges ,248.63,75,,,percent of total billed charges,75% of total billed charges ,265.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,167.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,248.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,89.04,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,89.04,265.2,
DESTRUCTION MALIGNANT LESION,1417280,CDM,521,RC,17280,HCPCS,Outpatient,,,305,152.5,,81.92,26.86,,,percent of total billed charges,26.86% of total billed charges,228.75,75,,,percent of total billed charges,75% of total billed charges ,228.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,228.75,75,,,percent of total billed charges,75% of total billed charges ,228.75,75,,,percent of total billed charges,75% of total billed charges ,244,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,153.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,228.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,81.92,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,81.92,244,
CRYO SURGERY-ACNE,1417340,CDM,521,RC,17340,HCPCS,Outpatient,,,110,55,,29.55,26.86,,,percent of total billed charges,26.86% of total billed charges,82.5,75,,,percent of total billed charges,75% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,82.5,75,,,percent of total billed charges,75% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,88,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,29.55,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,29.55,241.16,
PUNCTURE ASPIRATION OF CYST OF BREAST,1419000,CDM,521,RC,19000,HCPCS,Outpatient,,,240,120,,64.46,26.86,,,percent of total billed charges,26.86% of total billed charges,180,75,,,percent of total billed charges,75% of total billed charges ,180,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,180,75,,,percent of total billed charges,75% of total billed charges ,180,75,,,percent of total billed charges,75% of total billed charges ,192,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,120.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,180,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,64.46,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,64.46,241.16,
EXCISION OF CYST OF BREAST,1419120,CDM,521,RC,19120,HCPCS,Outpatient,,,1371,685.5,,368.25,26.86,,,percent of total billed charges,26.86% of total billed charges,1028.25,75,,,percent of total billed charges,75% of total billed charges ,1028.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1028.25,75,,,percent of total billed charges,75% of total billed charges ,1028.25,75,,,percent of total billed charges,75% of total billed charges ,1096.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,690.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,1028.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,368.25,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1096.8,
EXCISION OF BREAST LESION,1419125,CDM,521,RC,19125,HCPCS,Outpatient,,,1645,822.5,,441.85,26.86,,,percent of total billed charges,26.86% of total billed charges,1233.75,75,,,percent of total billed charges,75% of total billed charges ,1233.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1233.75,75,,,percent of total billed charges,75% of total billed charges ,1233.75,75,,,percent of total billed charges,75% of total billed charges ,1316,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,829.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,1233.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,441.85,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1316,
H1N1 VACCINATION ADMINISTRATION,1419141,CDM,521,RC,90471,HCPCS,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,7.25,241.16,
MASTECTOMY PARTIAL LUMPECTOMY,1419301,CDM,521,RC,19301,HCPCS,Outpatient,,,1470,735,,394.84,26.86,,,percent of total billed charges,26.86% of total billed charges,1102.5,75,,,percent of total billed charges,75% of total billed charges ,1102.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1102.5,75,,,percent of total billed charges,75% of total billed charges ,1102.5,75,,,percent of total billed charges,75% of total billed charges ,1176,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,740.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,1102.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,394.84,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1176,
MASTECTOMY MODIFIED RADICAL,1419307,CDM,521,RC,19307,HCPCS,Outpatient,,,3841,1920.5,,1031.69,26.86,,,percent of total billed charges,26.86% of total billed charges,2880.75,75,,,percent of total billed charges,75% of total billed charges ,2880.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,2880.75,75,,,percent of total billed charges,75% of total billed charges ,2880.75,75,,,percent of total billed charges,75% of total billed charges ,3072.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1935.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,2880.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,1031.69,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,3072.8,
INJECTION ADRENALINE UP TO 1 ML AMPULE,1420170,CDM,636,RC,J0171,HCPCS,Outpatient,,,3,1.5,,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.4,80,,,percent of total billed charges,80% of total billed charges ,0.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,1.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,0.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.94,31.2,,,percent of total billed charges,31.2% of total billed charges,2.4,80,,,percent of total billed charges,80% of total billed charges,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.72,2.4,
INJECTION THERAPEUTIC CARPAL TUNNEL,1420526,CDM,521,RC,20526,HCPCS,Outpatient,,,233,116.5,,62.58,26.86,,,percent of total billed charges,26.86% of total billed charges,174.75,75,,,percent of total billed charges,75% of total billed charges ,174.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,174.75,75,,,percent of total billed charges,75% of total billed charges ,174.75,75,,,percent of total billed charges,75% of total billed charges ,186.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,117.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,174.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,62.58,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,62.58,241.16,
INJ SINGLE TENDON SHEATH OR LIGAMENT APO,1420550,CDM,521,RC,20550,HCPCS,Outpatient,,,173,86.5,,46.47,26.86,,,percent of total billed charges,26.86% of total billed charges,129.75,75,,,percent of total billed charges,75% of total billed charges ,129.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,129.75,75,,,percent of total billed charges,75% of total billed charges ,129.75,75,,,percent of total billed charges,75% of total billed charges ,138.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,87.19,50.4,,,percent of total billed charges,50.4% of total billed charges ,129.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,46.47,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,46.47,241.16,
INJECTION(S) SINGLE TENDON ORIGIN/INSERT,1420551,CDM,521,RC,20551,HCPCS,Outpatient,,,178,89,,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,47.81,241.16,
TRIGGER PT INJECTION,1420552,CDM,521,RC,20552,HCPCS,Outpatient,,,179,89.5,,48.08,26.86,,,percent of total billed charges,26.86% of total billed charges,134.25,75,,,percent of total billed charges,75% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,134.25,75,,,percent of total billed charges,75% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,143.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,90.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,48.08,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,48.08,241.16,
INJECT SINGLE/MULTIPLE TRIGGER POINT 3 O,1420553,CDM,521,RC,20553,HCPCS,Outpatient,,,210,105,,56.41,26.86,,,percent of total billed charges,26.86% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,157.5,75,,,percent of total billed charges,75% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,168,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,105.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,56.41,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,56.41,241.16,
ARTHROCENTESIS ASPIRATION AND/OR INJECTI,1420600,CDM,521,RC,20600,HCPCS,Outpatient,,,178,89,,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,47.81,241.16,
ARTHROCENTESIS ASPIRATION AND/OR INJECTI,1420605,CDM,521,RC,20605,HCPCS,Outpatient,,,184.5,92.25,,49.56,26.86,,,percent of total billed charges,26.86% of total billed charges,138.38,75,,,percent of total billed charges,75% of total billed charges ,138.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,138.38,75,,,percent of total billed charges,75% of total billed charges ,138.38,75,,,percent of total billed charges,75% of total billed charges ,147.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,92.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,138.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,49.56,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,49.56,241.16,
ARTHROCENTESIS ASPIRATION OR INJECTION M,1420610,CDM,521,RC,20610,HCPCS,Outpatient,,,218.5,109.25,,58.69,26.86,,,percent of total billed charges,26.86% of total billed charges,163.88,75,,,percent of total billed charges,75% of total billed charges ,163.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,163.88,75,,,percent of total billed charges,75% of total billed charges ,163.88,75,,,percent of total billed charges,75% of total billed charges ,174.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,110.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,163.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,58.69,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,58.69,241.16,
SUTURE REMOVAL,1420670,CDM,521,RC,20670,HCPCS,Outpatient,,,1094,547,,293.85,26.86,,,percent of total billed charges,26.86% of total billed charges,820.5,75,,,percent of total billed charges,75% of total billed charges ,820.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,820.5,75,,,percent of total billed charges,75% of total billed charges ,820.5,75,,,percent of total billed charges,75% of total billed charges ,875.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,551.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,820.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,293.85,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,875.2,
ROCEPHIN ANTIBIOTIC INJECTION PER 250 MG,1420696,CDM,636,RC,J0696,HCPCS,Outpatient,,,4,2,,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.2,80,,,percent of total billed charges,80% of total billed charges ,0.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,2.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,3,75,,,percent of total billed charges,75% of total billed charges ,0.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,0.96,24,,,percent of total billed charges,24% of total billed charges ,1.25,31.2,,,percent of total billed charges,31.2% of total billed charges,3.2,80,,,percent of total billed charges,80% of total billed charges,0.96,24,,,percent of total billed charges,24% of total billed charges ,0.96,24,,,percent of total billed charges,24% of total billed charges ,0.49,3.2,
INJECTION BETAMETHASONE SODIUM PHOSPATE,1420702,CDM,636,RC,J0702,HCPCS,Outpatient,,,4,2,,6.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.2,80,,,percent of total billed charges,80% of total billed charges ,0.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,2.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,3,75,,,percent of total billed charges,75% of total billed charges ,0.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,0.96,24,,,percent of total billed charges,24% of total billed charges ,1.25,31.2,,,percent of total billed charges,31.2% of total billed charges,3.2,80,,,percent of total billed charges,80% of total billed charges,0.96,24,,,percent of total billed charges,24% of total billed charges ,0.96,24,,,percent of total billed charges,24% of total billed charges ,0.96,6.82,
INJECTION BETAMETHASONE SODIUM PHOSPHATE,1420704,CDM,636,RC,J0702,HCPCS,Outpatient,,,4,2,,6.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.2,80,,,percent of total billed charges,80% of total billed charges ,0.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,2.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,3,75,,,percent of total billed charges,75% of total billed charges ,0.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,0.96,24,,,percent of total billed charges,24% of total billed charges ,1.25,31.2,,,percent of total billed charges,31.2% of total billed charges,3.2,80,,,percent of total billed charges,80% of total billed charges,0.96,24,,,percent of total billed charges,24% of total billed charges ,0.96,24,,,percent of total billed charges,24% of total billed charges ,0.96,6.82,
INJECTION DEPO-ESTRADIOL UP TO 5MG,1421000,CDM,636,RC,J1000,HCPCS,Outpatient,,,26,13,,35.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,35.75,
INJECTION METHYLPREDISOLONE ACETATE 40 M,1421030,CDM,636,RC,J1030,HCPCS,Outpatient,,,12.5,6.25,,6.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
INJECTION MEDROXYPROGESTERONE ACETATE FO,1421055,CDM,636,RC,J1050,HCPCS,Outpatient,,,93.5,46.75,,0.54,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,74.8,80,,,percent of total billed charges,80% of total billed charges ,22.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.54,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.44,24,,,percent of total billed charges,24% of total billed charges ,29.17,31.2,,,percent of total billed charges,31.2% of total billed charges,74.8,80,,,percent of total billed charges,80% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,0.54,74.8,
INJECTION TESTOSTERONE CYPIONATE AND EST,1421060,CDM,636,RC,J1060,HCPCS,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
INJECTION TESTOSERONE CYPIONATE UP TO 10,1421070,CDM,636,RC,J1071,HCPCS,Outpatient,,,13.5,6.75,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.8,80,,,percent of total billed charges,80% of total billed charges ,3.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.24,24,,,percent of total billed charges,24% of total billed charges ,4.21,31.2,,,percent of total billed charges,31.2% of total billed charges,10.8,80,,,percent of total billed charges,80% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,0.03,10.8,
TESTOSTERONE INJECTION,1421080,CDM,636,RC,J1071,HCPCS,Outpatient,,,19.5,9.75,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,0.03,15.6,
INJECTION DECADRON 1 MG,1421100,CDM,636,RC,J1100,HCPCS,Outpatient,,,32,16,,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,0.12,25.6,
INJECTION DIPHENHYDRAMINE HCI UP TO 50 M,1421200,CDM,636,RC,J1200,HCPCS,Outpatient,,,3,1.5,,0.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.4,80,,,percent of total billed charges,80% of total billed charges ,0.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,1.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,0.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.94,31.2,,,percent of total billed charges,31.2% of total billed charges,2.4,80,,,percent of total billed charges,80% of total billed charges,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.72,2.4,
TORADOL KETOROLAC PER 15 MG,1421885,CDM,636,RC,J1885,HCPCS,Outpatient,,,6,3,,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.8,80,,,percent of total billed charges,80% of total billed charges ,1.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.87,31.2,,,percent of total billed charges,31.2% of total billed charges,4.8,80,,,percent of total billed charges,80% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,0.49,4.8,
EXCISION TUMOR SOFT TISSU OF BACK,1421930,CDM,360,RC,21930,HCPCS,Outpatient,,,1692.5,846.25,,454.61,26.86,,,percent of total billed charges,26.86% of total billed charges,1269.38,75,,,percent of total billed charges,75% of total billed charges ,1269.38,75,,,percent of total billed charges,75% of total billed charges ,406.2,24,,,percent of total billed charges,24% of total billed charges ,1269.38,75,,,percent of total billed charges,75% of total billed charges ,1269.38,75,,,percent of total billed charges,75% of total billed charges ,1354,80,,,percent of total billed charges,80% of total billed charges ,410.26,24.24,,,percent of total billed charges,24.24% of total billed charges ,853.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,1269.38,75,,,percent of total billed charges,75% of total billed charges ,414.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,454.61,26.86,,,percent of total billed charges,26.86% of total billed charges,406.2,24,,,percent of total billed charges,24% of total billed charges ,528.06,31.2,,,percent of total billed charges,31.2% of total billed charges,1354,80,,,percent of total billed charges,80% of total billed charges,406.2,24,,,percent of total billed charges,24% of total billed charges ,406.2,24,,,percent of total billed charges,24% of total billed charges ,406.2,1354,
INJECTION LIDOCAINE FOR INTRAVENOUS INFU,1422001,CDM,636,RC,J2001,HCPCS,Outpatient,,,53.5,26.75,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.8,80,,,percent of total billed charges,80% of total billed charges ,12.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,13.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.84,24,,,percent of total billed charges,24% of total billed charges ,16.69,31.2,,,percent of total billed charges,31.2% of total billed charges,42.8,80,,,percent of total billed charges,80% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,0.03,42.8,
INJECTION MEPERIDINE PER 100 MG,1422175,CDM,636,RC,J2175,HCPCS,Outpatient,,,7,3.5,,7.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.6,80,,,percent of total billed charges,80% of total billed charges ,1.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,1.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,1.68,24,,,percent of total billed charges,24% of total billed charges ,2.18,31.2,,,percent of total billed charges,31.2% of total billed charges,5.6,80,,,percent of total billed charges,80% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,7.3,
INJECTION NALBUPHINE PER 10 MG,1422300,CDM,636,RC,J2300,HCPCS,Outpatient,,,4,2,,2.81,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.2,80,,,percent of total billed charges,80% of total billed charges ,0.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,2.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,3,75,,,percent of total billed charges,75% of total billed charges ,0.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.81,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,0.96,24,,,percent of total billed charges,24% of total billed charges ,1.25,31.2,,,percent of total billed charges,31.2% of total billed charges,3.2,80,,,percent of total billed charges,80% of total billed charges,0.96,24,,,percent of total billed charges,24% of total billed charges ,0.96,24,,,percent of total billed charges,24% of total billed charges ,0.96,3.2,
INJECTION PHENERGEN PER 50 MG,1422550,CDM,636,RC,J2550,HCPCS,Outpatient,,,6,3,,3.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.8,80,,,percent of total billed charges,80% of total billed charges ,1.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.87,31.2,,,percent of total billed charges,31.2% of total billed charges,4.8,80,,,percent of total billed charges,80% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,4.8,
KENALOG INJECTION,1423301,CDM,636,RC,J3301,HCPCS,Outpatient,,,6,3,,0.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.8,80,,,percent of total billed charges,80% of total billed charges ,1.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.87,31.2,,,percent of total billed charges,31.2% of total billed charges,4.8,80,,,percent of total billed charges,80% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,0.95,4.8,
INJECTION HYDROXYZINE HCL VISTARIL UP TO,1423410,CDM,636,RC,J3410,HCPCS,Outpatient,,,4,2,,9.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.2,80,,,percent of total billed charges,80% of total billed charges ,0.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,2.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,3,75,,,percent of total billed charges,75% of total billed charges ,0.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,0.96,24,,,percent of total billed charges,24% of total billed charges ,1.25,31.2,,,percent of total billed charges,31.2% of total billed charges,3.2,80,,,percent of total billed charges,80% of total billed charges,0.96,24,,,percent of total billed charges,24% of total billed charges ,0.96,24,,,percent of total billed charges,24% of total billed charges ,0.96,9.91,
B-12 INJECTION UP TO 1000 MCG,1423420,CDM,636,RC,J3420,HCPCS,Outpatient,,,8,4,,1.44,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.4,80,,,percent of total billed charges,80% of total billed charges ,1.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.44,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,1.92,24,,,percent of total billed charges,24% of total billed charges ,2.5,31.2,,,percent of total billed charges,31.2% of total billed charges,6.4,80,,,percent of total billed charges,80% of total billed charges,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.44,6.4,
EXCISION TUMOR SOFT TISSUE OF UPPER ARM,1424075,CDM,360,RC,24075,HCPCS,Outpatient,,,1866.5,933.25,,501.34,26.86,,,percent of total billed charges,26.86% of total billed charges,1399.88,75,,,percent of total billed charges,75% of total billed charges ,1399.88,75,,,percent of total billed charges,75% of total billed charges ,447.96,24,,,percent of total billed charges,24% of total billed charges ,1399.88,75,,,percent of total billed charges,75% of total billed charges ,1399.88,75,,,percent of total billed charges,75% of total billed charges ,1493.2,80,,,percent of total billed charges,80% of total billed charges ,452.44,24.24,,,percent of total billed charges,24.24% of total billed charges ,940.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,1399.88,75,,,percent of total billed charges,75% of total billed charges ,456.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,501.34,26.86,,,percent of total billed charges,26.86% of total billed charges,447.96,24,,,percent of total billed charges,24% of total billed charges ,582.35,31.2,,,percent of total billed charges,31.2% of total billed charges,1493.2,80,,,percent of total billed charges,80% of total billed charges,447.96,24,,,percent of total billed charges,24% of total billed charges ,447.96,24,,,percent of total billed charges,24% of total billed charges ,447.96,1493.2,
REMOVAL FOREIGN BODY UPPER ARM,1424200,CDM,521,RC,24200,HCPCS,Outpatient,,,262.5,131.25,,70.51,26.86,,,percent of total billed charges,26.86% of total billed charges,196.88,75,,,percent of total billed charges,75% of total billed charges ,196.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,196.88,75,,,percent of total billed charges,75% of total billed charges ,196.88,75,,,percent of total billed charges,75% of total billed charges ,210,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,132.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,196.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,70.51,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,70.51,241.16,
EXCISION OF GANGLION CYST WRIST,1425111,CDM,521,RC,25111,HCPCS,Outpatient,,,1514,757,,406.66,26.86,,,percent of total billed charges,26.86% of total billed charges,1135.5,75,,,percent of total billed charges,75% of total billed charges ,1135.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1135.5,75,,,percent of total billed charges,75% of total billed charges ,1135.5,75,,,percent of total billed charges,75% of total billed charges ,1211.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,763.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,1135.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,406.66,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1211.2,
ALBUTEROL INHALATION SOLUTION,1427613,CDM,250,RC,J7613,HCPCS,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
LEVALBUTEROL INHAL SOL NONCOMPOUNDED UN,1427614,CDM,250,RC,J7614,HCPCS,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
ATROVENT NONCOMPOUNDED UNIT DOSE FORM PE,1427644,CDM,250,RC,J7644,HCPCS,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
APPLICATION OF SHORT ARM SPLINT (FOREARM,1429125,CDM,521,RC,29125,HCPCS,Outpatient,,,190.5,95.25,,51.17,26.86,,,percent of total billed charges,26.86% of total billed charges,142.88,75,,,percent of total billed charges,75% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,142.88,75,,,percent of total billed charges,75% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,152.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,96.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,51.17,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,51.17,241.16,
APPLICATION OF FINGER SPLINT STATIC,1429130,CDM,521,RC,29130,HCPCS,Outpatient,,,127.5,63.75,,34.25,26.86,,,percent of total billed charges,26.86% of total billed charges,95.63,75,,,percent of total billed charges,75% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,95.63,75,,,percent of total billed charges,75% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,102,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,64.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,34.25,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,34.25,241.16,
UNNA BOOT,1429580,CDM,521,RC,29580,HCPCS,Outpatient,,,122.5,61.25,,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,98,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,61.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,32.9,241.16,
DENIS-BROWNE SPLNT-LEG SPLINT,1429590,CDM,521,RC,29581,HCPCS,Outpatient,,,153.5,76.75,,41.23,26.86,,,percent of total billed charges,26.86% of total billed charges,115.13,75,,,percent of total billed charges,75% of total billed charges ,115.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,115.13,75,,,percent of total billed charges,75% of total billed charges ,115.13,75,,,percent of total billed charges,75% of total billed charges ,122.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,77.36,50.4,,,percent of total billed charges,50.4% of total billed charges ,115.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,41.23,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,41.23,241.16,
TRACHEOSTOMY PLANNED,1431600,CDM,521,RC,31600,HCPCS,Outpatient,,,1649,824.5,,442.92,26.86,,,percent of total billed charges,26.86% of total billed charges,1236.75,75,,,percent of total billed charges,75% of total billed charges ,1236.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1236.75,75,,,percent of total billed charges,75% of total billed charges ,1236.75,75,,,percent of total billed charges,75% of total billed charges ,1319.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,831.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,1236.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,442.92,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1319.2,
TUBE THORACOSTOMY INCLUDES WATER SEAL,1432551,CDM,521,RC,32551,HCPCS,Outpatient,,,701.5,350.75,,188.42,26.86,,,percent of total billed charges,26.86% of total billed charges,526.13,75,,,percent of total billed charges,75% of total billed charges ,526.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,526.13,75,,,percent of total billed charges,75% of total billed charges ,526.13,75,,,percent of total billed charges,75% of total billed charges ,561.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,353.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,526.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,188.42,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,561.2,
VENIPUNCTURE,1436415,CDM,300,RC,36415,HCPCS,Outpatient,,,21,10.5,,5.64,26.86,,,percent of total billed charges,26.86% of total billed charges,15.75,75,,,percent of total billed charges,75% of total billed charges ,15.75,75,,,percent of total billed charges,75% of total billed charges ,5.04,24,,,percent of total billed charges,24% of total billed charges ,15.75,75,,,percent of total billed charges,75% of total billed charges ,15.75,75,,,percent of total billed charges,75% of total billed charges ,16.8,80,,,percent of total billed charges,80% of total billed charges ,5.09,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.75,75,,,percent of total billed charges,75% of total billed charges ,5.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.64,26.86,,,percent of total billed charges,26.86% of total billed charges,5.04,24,,,percent of total billed charges,24% of total billed charges ,6.55,31.2,,,percent of total billed charges,31.2% of total billed charges,16.8,80,,,percent of total billed charges,80% of total billed charges,5.04,24,,,percent of total billed charges,24% of total billed charges ,5.04,24,,,percent of total billed charges,24% of total billed charges ,5.04,16.8,
INSERTION GROSHON/HICKMAN CENTRAL LINE >,1436558,CDM,521,RC,36558,HCPCS,Outpatient,,,2406,1203,,646.25,26.86,,,percent of total billed charges,26.86% of total billed charges,1804.5,75,,,percent of total billed charges,75% of total billed charges ,1804.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1804.5,75,,,percent of total billed charges,75% of total billed charges ,1804.5,75,,,percent of total billed charges,75% of total billed charges ,1924.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1212.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,1804.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,646.25,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1924.8,
INSERTION TUNNELED CENTRAL LINE/PORT A C,1436561,CDM,521,RC,36561,HCPCS,Outpatient,,,2187.5,1093.75,,587.56,26.86,,,percent of total billed charges,26.86% of total billed charges,1640.63,75,,,percent of total billed charges,75% of total billed charges ,1640.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1640.63,75,,,percent of total billed charges,75% of total billed charges ,1640.63,75,,,percent of total billed charges,75% of total billed charges ,1750,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1102.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,1640.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,587.56,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1750,
SPLENECTOMY TOTAL,1438100,CDM,521,RC,38100,HCPCS,Outpatient,,,7110,3555,,1909.75,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,5688,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,3583.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,5332.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,1909.75,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,5688,
EGD UPPER GASTROINESTINAL EDOSCOPY DIAGN,1443235,CDM,360,RC,43235,HCPCS,Outpatient,,,826,413,,221.86,26.86,,,percent of total billed charges,26.86% of total billed charges,619.5,75,,,percent of total billed charges,75% of total billed charges ,619.5,75,,,percent of total billed charges,75% of total billed charges ,198.24,24,,,percent of total billed charges,24% of total billed charges ,619.5,75,,,percent of total billed charges,75% of total billed charges ,619.5,75,,,percent of total billed charges,75% of total billed charges ,660.8,80,,,percent of total billed charges,80% of total billed charges ,200.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,416.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,619.5,75,,,percent of total billed charges,75% of total billed charges ,202.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,221.86,26.86,,,percent of total billed charges,26.86% of total billed charges,198.24,24,,,percent of total billed charges,24% of total billed charges ,257.71,31.2,,,percent of total billed charges,31.2% of total billed charges,660.8,80,,,percent of total billed charges,80% of total billed charges,198.24,24,,,percent of total billed charges,24% of total billed charges ,198.24,24,,,percent of total billed charges,24% of total billed charges ,198.24,660.8,
EGD WITH BIOPSY UPPER GASTROINTESTINAL E,1443239,CDM,360,RC,43239,HCPCS,Outpatient,,,958,479,,257.32,26.86,,,percent of total billed charges,26.86% of total billed charges,718.5,75,,,percent of total billed charges,75% of total billed charges ,718.5,75,,,percent of total billed charges,75% of total billed charges ,229.92,24,,,percent of total billed charges,24% of total billed charges ,718.5,75,,,percent of total billed charges,75% of total billed charges ,718.5,75,,,percent of total billed charges,75% of total billed charges ,766.4,80,,,percent of total billed charges,80% of total billed charges ,232.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,482.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,718.5,75,,,percent of total billed charges,75% of total billed charges ,234.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,257.32,26.86,,,percent of total billed charges,26.86% of total billed charges,229.92,24,,,percent of total billed charges,24% of total billed charges ,298.9,31.2,,,percent of total billed charges,31.2% of total billed charges,766.4,80,,,percent of total billed charges,80% of total billed charges,229.92,24,,,percent of total billed charges,24% of total billed charges ,229.92,24,,,percent of total billed charges,24% of total billed charges ,229.92,766.4,
EGD WITH BAND LIGATION OF ESOPHAGEAL AND,1443244,CDM,360,RC,43244,HCPCS,Outpatient,,,1226.5,613.25,,329.44,26.86,,,percent of total billed charges,26.86% of total billed charges,919.88,75,,,percent of total billed charges,75% of total billed charges ,919.88,75,,,percent of total billed charges,75% of total billed charges ,294.36,24,,,percent of total billed charges,24% of total billed charges ,919.88,75,,,percent of total billed charges,75% of total billed charges ,919.88,75,,,percent of total billed charges,75% of total billed charges ,981.2,80,,,percent of total billed charges,80% of total billed charges ,297.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,618.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,919.88,75,,,percent of total billed charges,75% of total billed charges ,300.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,329.44,26.86,,,percent of total billed charges,26.86% of total billed charges,294.36,24,,,percent of total billed charges,24% of total billed charges ,382.67,31.2,,,percent of total billed charges,31.2% of total billed charges,981.2,80,,,percent of total billed charges,80% of total billed charges,294.36,24,,,percent of total billed charges,24% of total billed charges ,294.36,24,,,percent of total billed charges,24% of total billed charges ,294.36,981.2,
UP GI ENDO W/DILAT GASTRIC OUT OBSTR (BA,1443245,CDM,360,RC,43245,HCPCS,Outpatient,,,984.5,492.25,,264.44,26.86,,,percent of total billed charges,26.86% of total billed charges,738.38,75,,,percent of total billed charges,75% of total billed charges ,738.38,75,,,percent of total billed charges,75% of total billed charges ,236.28,24,,,percent of total billed charges,24% of total billed charges ,738.38,75,,,percent of total billed charges,75% of total billed charges ,738.38,75,,,percent of total billed charges,75% of total billed charges ,787.6,80,,,percent of total billed charges,80% of total billed charges ,238.64,24.24,,,percent of total billed charges,24.24% of total billed charges ,496.19,50.4,,,percent of total billed charges,50.4% of total billed charges ,738.38,75,,,percent of total billed charges,75% of total billed charges ,241.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,264.44,26.86,,,percent of total billed charges,26.86% of total billed charges,236.28,24,,,percent of total billed charges,24% of total billed charges ,307.16,31.2,,,percent of total billed charges,31.2% of total billed charges,787.6,80,,,percent of total billed charges,80% of total billed charges,236.28,24,,,percent of total billed charges,24% of total billed charges ,236.28,24,,,percent of total billed charges,24% of total billed charges ,236.28,787.6,
EGD WITH PEG TUBE PLACEMENT,1443246,CDM,360,RC,43246,HCPCS,Outpatient,,,1653,826.5,,444,26.86,,,percent of total billed charges,26.86% of total billed charges,1239.75,75,,,percent of total billed charges,75% of total billed charges ,1239.75,75,,,percent of total billed charges,75% of total billed charges ,396.72,24,,,percent of total billed charges,24% of total billed charges ,1239.75,75,,,percent of total billed charges,75% of total billed charges ,1239.75,75,,,percent of total billed charges,75% of total billed charges ,1322.4,80,,,percent of total billed charges,80% of total billed charges ,400.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,833.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,1239.75,75,,,percent of total billed charges,75% of total billed charges ,404.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,444,26.86,,,percent of total billed charges,26.86% of total billed charges,396.72,24,,,percent of total billed charges,24% of total billed charges ,515.74,31.2,,,percent of total billed charges,31.2% of total billed charges,1322.4,80,,,percent of total billed charges,80% of total billed charges,396.72,24,,,percent of total billed charges,24% of total billed charges ,396.72,24,,,percent of total billed charges,24% of total billed charges ,396.72,1322.4,
UPPER GASTROINTESTINAL ENDOSCOPY WITH RE,1443247,CDM,360,RC,43247,HCPCS,Outpatient,,,984.5,492.25,,264.44,26.86,,,percent of total billed charges,26.86% of total billed charges,738.38,75,,,percent of total billed charges,75% of total billed charges ,738.38,75,,,percent of total billed charges,75% of total billed charges ,236.28,24,,,percent of total billed charges,24% of total billed charges ,738.38,75,,,percent of total billed charges,75% of total billed charges ,738.38,75,,,percent of total billed charges,75% of total billed charges ,787.6,80,,,percent of total billed charges,80% of total billed charges ,238.64,24.24,,,percent of total billed charges,24.24% of total billed charges ,496.19,50.4,,,percent of total billed charges,50.4% of total billed charges ,738.38,75,,,percent of total billed charges,75% of total billed charges ,241.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,264.44,26.86,,,percent of total billed charges,26.86% of total billed charges,236.28,24,,,percent of total billed charges,24% of total billed charges ,307.16,31.2,,,percent of total billed charges,31.2% of total billed charges,787.6,80,,,percent of total billed charges,80% of total billed charges,236.28,24,,,percent of total billed charges,24% of total billed charges ,236.28,24,,,percent of total billed charges,24% of total billed charges ,236.28,787.6,
UP GI ENDO W/ INSERT GUIDE WIRE THEN DIL,1443248,CDM,360,RC,43248,HCPCS,Outpatient,,,956,478,,256.78,26.86,,,percent of total billed charges,26.86% of total billed charges,717,75,,,percent of total billed charges,75% of total billed charges ,717,75,,,percent of total billed charges,75% of total billed charges ,229.44,24,,,percent of total billed charges,24% of total billed charges ,717,75,,,percent of total billed charges,75% of total billed charges ,717,75,,,percent of total billed charges,75% of total billed charges ,764.8,80,,,percent of total billed charges,80% of total billed charges ,231.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,481.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,717,75,,,percent of total billed charges,75% of total billed charges ,234.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,256.78,26.86,,,percent of total billed charges,26.86% of total billed charges,229.44,24,,,percent of total billed charges,24% of total billed charges ,298.27,31.2,,,percent of total billed charges,31.2% of total billed charges,764.8,80,,,percent of total billed charges,80% of total billed charges,229.44,24,,,percent of total billed charges,24% of total billed charges ,229.44,24,,,percent of total billed charges,24% of total billed charges ,229.44,764.8,
UPPER GI ENDOSCOPY WITH BALLOON DILATION,1443249,CDM,360,RC,43249,HCPCS,Outpatient,,,1046.5,523.25,,281.09,26.86,,,percent of total billed charges,26.86% of total billed charges,784.88,75,,,percent of total billed charges,75% of total billed charges ,784.88,75,,,percent of total billed charges,75% of total billed charges ,251.16,24,,,percent of total billed charges,24% of total billed charges ,784.88,75,,,percent of total billed charges,75% of total billed charges ,784.88,75,,,percent of total billed charges,75% of total billed charges ,837.2,80,,,percent of total billed charges,80% of total billed charges ,253.67,24.24,,,percent of total billed charges,24.24% of total billed charges ,527.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,784.88,75,,,percent of total billed charges,75% of total billed charges ,256.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,281.09,26.86,,,percent of total billed charges,26.86% of total billed charges,251.16,24,,,percent of total billed charges,24% of total billed charges ,326.51,31.2,,,percent of total billed charges,31.2% of total billed charges,837.2,80,,,percent of total billed charges,80% of total billed charges,251.16,24,,,percent of total billed charges,24% of total billed charges ,251.16,24,,,percent of total billed charges,24% of total billed charges ,251.16,837.2,
UP GI ENDOSCOPY WITH REMOVAL OF TUMOR PO,1443251,CDM,360,RC,43251,HCPCS,Outpatient,,,1190.5,595.25,,319.77,26.86,,,percent of total billed charges,26.86% of total billed charges,892.88,75,,,percent of total billed charges,75% of total billed charges ,892.88,75,,,percent of total billed charges,75% of total billed charges ,285.72,24,,,percent of total billed charges,24% of total billed charges ,892.88,75,,,percent of total billed charges,75% of total billed charges ,892.88,75,,,percent of total billed charges,75% of total billed charges ,952.4,80,,,percent of total billed charges,80% of total billed charges ,288.58,24.24,,,percent of total billed charges,24.24% of total billed charges ,600.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,892.88,75,,,percent of total billed charges,75% of total billed charges ,291.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,319.77,26.86,,,percent of total billed charges,26.86% of total billed charges,285.72,24,,,percent of total billed charges,24% of total billed charges ,371.44,31.2,,,percent of total billed charges,31.2% of total billed charges,952.4,80,,,percent of total billed charges,80% of total billed charges,285.72,24,,,percent of total billed charges,24% of total billed charges ,285.72,24,,,percent of total billed charges,24% of total billed charges ,285.72,952.4,
EGD WITH CONTROL OF BLEEDING ANY METHOD,1443255,CDM,360,RC,43255,HCPCS,Outpatient,,,1263,631.5,,339.24,26.86,,,percent of total billed charges,26.86% of total billed charges,947.25,75,,,percent of total billed charges,75% of total billed charges ,947.25,75,,,percent of total billed charges,75% of total billed charges ,303.12,24,,,percent of total billed charges,24% of total billed charges ,947.25,75,,,percent of total billed charges,75% of total billed charges ,947.25,75,,,percent of total billed charges,75% of total billed charges ,1010.4,80,,,percent of total billed charges,80% of total billed charges ,306.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,636.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,947.25,75,,,percent of total billed charges,75% of total billed charges ,309.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,339.24,26.86,,,percent of total billed charges,26.86% of total billed charges,303.12,24,,,percent of total billed charges,24% of total billed charges ,394.06,31.2,,,percent of total billed charges,31.2% of total billed charges,1010.4,80,,,percent of total billed charges,80% of total billed charges,303.12,24,,,percent of total billed charges,24% of total billed charges ,303.12,24,,,percent of total billed charges,24% of total billed charges ,303.12,1010.4,
DILATION OF ESOPHAGUS BY UNGUIDED SOUND,1443450,CDM,360,RC,43450,HCPCS,Outpatient,,,302,151,,81.12,26.86,,,percent of total billed charges,26.86% of total billed charges,226.5,75,,,percent of total billed charges,75% of total billed charges ,226.5,75,,,percent of total billed charges,75% of total billed charges ,72.48,24,,,percent of total billed charges,24% of total billed charges ,226.5,75,,,percent of total billed charges,75% of total billed charges ,226.5,75,,,percent of total billed charges,75% of total billed charges ,241.6,80,,,percent of total billed charges,80% of total billed charges ,73.2,24.24,,,percent of total billed charges,24.24% of total billed charges ,152.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,226.5,75,,,percent of total billed charges,75% of total billed charges ,73.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,81.12,26.86,,,percent of total billed charges,26.86% of total billed charges,72.48,24,,,percent of total billed charges,24% of total billed charges ,94.22,31.2,,,percent of total billed charges,31.2% of total billed charges,241.6,80,,,percent of total billed charges,80% of total billed charges,72.48,24,,,percent of total billed charges,24% of total billed charges ,72.48,24,,,percent of total billed charges,24% of total billed charges ,72.48,241.6,
CHANGE OF GASTOSTOMY TUBE PERCUTANIOUS W,1443760,CDM,521,RC,43762,HCPCS,Outpatient,,,416,208,,111.74,26.86,,,percent of total billed charges,26.86% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges ,312,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,312,75,,,percent of total billed charges,75% of total billed charges ,312,75,,,percent of total billed charges,75% of total billed charges ,332.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,209.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,312,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,111.74,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,111.74,332.8,
MOBILIZATION OF SPLENIC FLEXURE,1444139,CDM,521,RC,44139,HCPCS,Outpatient,,,492.5,246.25,,132.29,26.86,,,percent of total billed charges,26.86% of total billed charges,369.38,75,,,percent of total billed charges,75% of total billed charges ,369.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,369.38,75,,,percent of total billed charges,75% of total billed charges ,369.38,75,,,percent of total billed charges,75% of total billed charges ,394,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,248.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,369.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,132.29,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,132.29,394,
COLECTOMY PARTIAL,1444140,CDM,521,RC,44140,HCPCS,Outpatient,,,4681.5,2340.75,,1257.45,26.86,,,percent of total billed charges,26.86% of total billed charges,3511.13,75,,,percent of total billed charges,75% of total billed charges ,3511.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,3511.13,75,,,percent of total billed charges,75% of total billed charges ,3511.13,75,,,percent of total billed charges,75% of total billed charges ,3745.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,2359.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,3511.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,1257.45,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,3745.2,
COLECTOMY PARTIAL W/ END COLOSTOMY AND C,1444143,CDM,521,RC,44143,HCPCS,Outpatient,,,4777,2388.5,,1283.1,26.86,,,percent of total billed charges,26.86% of total billed charges,3582.75,75,,,percent of total billed charges,75% of total billed charges ,3582.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,3582.75,75,,,percent of total billed charges,75% of total billed charges ,3582.75,75,,,percent of total billed charges,75% of total billed charges ,3821.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,2407.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,3582.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,1283.1,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,3821.6,
COLECTOMY PARTIAL W/ COLOPROCTOSTOMY W/,1444146,CDM,521,RC,44146,HCPCS,Outpatient,,,7343,3671.5,,1972.33,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,5874.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,3700.87,50.4,,,percent of total billed charges,50.4% of total billed charges ,5507.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,1972.33,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,5874.4,
COLECTOMY PARTIAL W/ REMOVAL OF TERMINAL,1444160,CDM,521,RC,44160,HCPCS,Outpatient,,,4435,2217.5,,1191.24,26.86,,,percent of total billed charges,26.86% of total billed charges,3326.25,75,,,percent of total billed charges,75% of total billed charges ,3326.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,3326.25,75,,,percent of total billed charges,75% of total billed charges ,3326.25,75,,,percent of total billed charges,75% of total billed charges ,3548,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,2235.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,3326.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,1191.24,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,3548,
COLECTOMY PARTIAL W/ ANASTOMOSIS,1444204,CDM,521,RC,44204,HCPCS,Outpatient,,,5173.5,2586.75,,1389.6,26.86,,,percent of total billed charges,26.86% of total billed charges,3880.13,75,,,percent of total billed charges,75% of total billed charges ,3880.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,3880.13,75,,,percent of total billed charges,75% of total billed charges ,3880.13,75,,,percent of total billed charges,75% of total billed charges ,4138.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,2607.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,3880.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,1389.6,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,4138.8,
COLECTOMY PARTIAL W/REMOVAL TERMINAL ILE,1444205,CDM,521,RC,44205,HCPCS,Outpatient,,,4927.5,2463.75,,1323.53,26.86,,,percent of total billed charges,26.86% of total billed charges,3695.63,75,,,percent of total billed charges,75% of total billed charges ,3695.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,3695.63,75,,,percent of total billed charges,75% of total billed charges ,3695.63,75,,,percent of total billed charges,75% of total billed charges ,3942,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,2483.46,50.4,,,percent of total billed charges,50.4% of total billed charges ,3695.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,1323.53,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,3942,
COLECTOMY PARTIAL W/ ANASTOMOSIS W/ COLO,1444207,CDM,521,RC,44207,HCPCS,Outpatient,,,6404.5,3202.25,,1720.25,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,5123.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,3227.87,50.4,,,percent of total billed charges,50.4% of total billed charges ,4803.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,1720.25,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,5123.6,
COLECTOMY PARTIAL W/ ANASTOMOSIS W/ COLO,1444208,CDM,521,RC,44208,HCPCS,Outpatient,,,6653,3326.5,,1787,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,5322.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,3353.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,4989.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,1787,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,5322.4,
COLECTOMY TOTAL ABDOMINAL W/ PROCTECTOMY,1444211,CDM,521,RC,44211,HCPCS,Outpatient,,,8624,4312,,2316.41,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,6899.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,4346.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,6468,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,2316.41,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,6899.2,
LAPAROSCOPY SURGICAL MOBILIZATION WITH P,1444213,CDM,521,RC,44213,HCPCS,Outpatient,,,738.5,369.25,,198.36,26.86,,,percent of total billed charges,26.86% of total billed charges,553.88,75,,,percent of total billed charges,75% of total billed charges ,553.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,553.88,75,,,percent of total billed charges,75% of total billed charges ,553.88,75,,,percent of total billed charges,75% of total billed charges ,590.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,372.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,553.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,198.36,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,590.8,
COLONOSCOPY THROUGH STOMA W/ REMOVAL OF,1444394,CDM,360,RC,44394,HCPCS,Outpatient,,,1796.5,898.25,,482.54,26.86,,,percent of total billed charges,26.86% of total billed charges,1347.38,75,,,percent of total billed charges,75% of total billed charges ,1347.38,75,,,percent of total billed charges,75% of total billed charges ,431.16,24,,,percent of total billed charges,24% of total billed charges ,1347.38,75,,,percent of total billed charges,75% of total billed charges ,1347.38,75,,,percent of total billed charges,75% of total billed charges ,1437.2,80,,,percent of total billed charges,80% of total billed charges ,435.47,24.24,,,percent of total billed charges,24.24% of total billed charges ,905.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,1347.38,75,,,percent of total billed charges,75% of total billed charges ,439.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,482.54,26.86,,,percent of total billed charges,26.86% of total billed charges,431.16,24,,,percent of total billed charges,24% of total billed charges ,560.51,31.2,,,percent of total billed charges,31.2% of total billed charges,1437.2,80,,,percent of total billed charges,80% of total billed charges,431.16,24,,,percent of total billed charges,24% of total billed charges ,431.16,24,,,percent of total billed charges,24% of total billed charges ,431.16,1437.2,
CLOSURE OF ENTEROSTOMY W/ RESECTION AND,1444626,CDM,521,RC,44626,HCPCS,Outpatient,,,3941,1970.5,,1058.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2955.75,75,,,percent of total billed charges,75% of total billed charges ,2955.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,2955.75,75,,,percent of total billed charges,75% of total billed charges ,2955.75,75,,,percent of total billed charges,75% of total billed charges ,3152.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1986.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,2955.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,1058.55,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,3152.8,
APPENDECTOMY,1444950,CDM,521,RC,44950,HCPCS,Outpatient,,,2356.5,1178.25,,632.96,26.86,,,percent of total billed charges,26.86% of total billed charges,1767.38,75,,,percent of total billed charges,75% of total billed charges ,1767.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1767.38,75,,,percent of total billed charges,75% of total billed charges ,1767.38,75,,,percent of total billed charges,75% of total billed charges ,1885.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1187.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,1767.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,632.96,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1885.2,
APPENDECTOMY RUPTURED OPEN,1444960,CDM,521,RC,44960,HCPCS,Outpatient,,,2945,1472.5,,791.03,26.86,,,percent of total billed charges,26.86% of total billed charges,2208.75,75,,,percent of total billed charges,75% of total billed charges ,2208.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,2208.75,75,,,percent of total billed charges,75% of total billed charges ,2208.75,75,,,percent of total billed charges,75% of total billed charges ,2356,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1484.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,2208.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,791.03,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,2356,
LAPARASCOPIC APPENDECTOMY,1444970,CDM,521,RC,44970,HCPCS,Outpatient,,,2887,1443.5,,775.45,26.86,,,percent of total billed charges,26.86% of total billed charges,2165.25,75,,,percent of total billed charges,75% of total billed charges ,2165.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,2165.25,75,,,percent of total billed charges,75% of total billed charges ,2165.25,75,,,percent of total billed charges,75% of total billed charges ,2309.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1455.05,50.4,,,percent of total billed charges,50.4% of total billed charges ,2165.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,775.45,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,2309.6,
PROTECTOMY COMPLETE COMBINED ABDOMINOPER,1445110,CDM,521,RC,45110,HCPCS,Outpatient,,,6775.5,3387.75,,1819.9,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,5420.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,3414.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,5081.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,1819.9,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,5420.4,
EXCISION OF RECTAL TUMOR TRANSANAL APPRO,1445171,CDM,521,RC,45171,HCPCS,Outpatient,,,2565.5,1282.75,,689.09,26.86,,,percent of total billed charges,26.86% of total billed charges,1924.13,75,,,percent of total billed charges,75% of total billed charges ,1924.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1924.13,75,,,percent of total billed charges,75% of total billed charges ,1924.13,75,,,percent of total billed charges,75% of total billed charges ,2052.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1293.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,1924.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,689.09,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,2052.4,
PROCTOSIGMOIDOSCOPY FIGID DIAGNOSTIC BY,1445300,CDM,521,RC,45300,HCPCS,Outpatient,,,214,107,,57.48,26.86,,,percent of total billed charges,26.86% of total billed charges,160.5,75,,,percent of total billed charges,75% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,160.5,75,,,percent of total billed charges,75% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,171.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,107.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,57.48,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,57.48,241.16,
SIGMOIDOSCOPY FLEXIBLE DIAGNOSTIC,1445330,CDM,521,RC,45330,HCPCS,Outpatient,,,416,208,,111.74,26.86,,,percent of total billed charges,26.86% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges ,312,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,312,75,,,percent of total billed charges,75% of total billed charges ,312,75,,,percent of total billed charges,75% of total billed charges ,332.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,209.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,312,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,111.74,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,111.74,332.8,
FLEX SIGMOID WITH BIOPSY SINGLE OR MULT,1445331,CDM,521,RC,45331,HCPCS,Outpatient,,,509,254.5,,136.72,26.86,,,percent of total billed charges,26.86% of total billed charges,381.75,75,,,percent of total billed charges,75% of total billed charges ,381.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,381.75,75,,,percent of total billed charges,75% of total billed charges ,381.75,75,,,percent of total billed charges,75% of total billed charges ,407.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,256.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,381.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,136.72,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,136.72,407.2,
SIGMOIDOSCOPY FLEX DX W/REMOVALTUMOR(S),1445338,CDM,521,RC,45338,HCPCS,Outpatient,,,1103,551.5,,296.27,26.86,,,percent of total billed charges,26.86% of total billed charges,827.25,75,,,percent of total billed charges,75% of total billed charges ,827.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,827.25,75,,,percent of total billed charges,75% of total billed charges ,827.25,75,,,percent of total billed charges,75% of total billed charges ,882.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,555.91,50.4,,,percent of total billed charges,50.4% of total billed charges ,827.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,296.27,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,882.4,
COLONOSCOPY,1445378,CDM,360,RC,,,Outpatient,,,1112.5,556.25,,298.82,26.86,,,percent of total billed charges,26.86% of total billed charges,834.38,75,,,percent of total billed charges,75% of total billed charges ,834.38,75,,,percent of total billed charges,75% of total billed charges ,267,24,,,percent of total billed charges,24% of total billed charges ,834.38,75,,,percent of total billed charges,75% of total billed charges ,834.38,75,,,percent of total billed charges,75% of total billed charges ,890,80,,,percent of total billed charges,80% of total billed charges ,269.67,24.24,,,percent of total billed charges,24.24% of total billed charges ,560.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,834.38,75,,,percent of total billed charges,75% of total billed charges ,272.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,298.82,26.86,,,percent of total billed charges,26.86% of total billed charges,267,24,,,percent of total billed charges,24% of total billed charges ,347.1,31.2,,,percent of total billed charges,31.2% of total billed charges,890,80,,,percent of total billed charges,80% of total billed charges,267,24,,,percent of total billed charges,24% of total billed charges ,267,24,,,percent of total billed charges,24% of total billed charges ,267,890,
COLONOSCOPY W/ BIOPSY,1445380,CDM,360,RC,45380,HCPCS,Outpatient,,,1224.5,612.25,,328.9,26.86,,,percent of total billed charges,26.86% of total billed charges,918.38,75,,,percent of total billed charges,75% of total billed charges ,918.38,75,,,percent of total billed charges,75% of total billed charges ,293.88,24,,,percent of total billed charges,24% of total billed charges ,918.38,75,,,percent of total billed charges,75% of total billed charges ,918.38,75,,,percent of total billed charges,75% of total billed charges ,979.6,80,,,percent of total billed charges,80% of total billed charges ,296.82,24.24,,,percent of total billed charges,24.24% of total billed charges ,617.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,918.38,75,,,percent of total billed charges,75% of total billed charges ,299.76,24.48,,,percent of total billed charges,24.48% of total billed charges ,328.9,26.86,,,percent of total billed charges,26.86% of total billed charges,293.88,24,,,percent of total billed charges,24% of total billed charges ,382.04,31.2,,,percent of total billed charges,31.2% of total billed charges,979.6,80,,,percent of total billed charges,80% of total billed charges,293.88,24,,,percent of total billed charges,24% of total billed charges ,293.88,24,,,percent of total billed charges,24% of total billed charges ,293.88,979.6,
COLONOSCOPY W/ DIRECTED SUBMUCOSAL INJUE,1445381,CDM,360,RC,45381,HCPCS,Outpatient,,,1379,689.5,,370.4,26.86,,,percent of total billed charges,26.86% of total billed charges,1034.25,75,,,percent of total billed charges,75% of total billed charges ,1034.25,75,,,percent of total billed charges,75% of total billed charges ,330.96,24,,,percent of total billed charges,24% of total billed charges ,1034.25,75,,,percent of total billed charges,75% of total billed charges ,1034.25,75,,,percent of total billed charges,75% of total billed charges ,1103.2,80,,,percent of total billed charges,80% of total billed charges ,334.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,695.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,1034.25,75,,,percent of total billed charges,75% of total billed charges ,337.58,24.48,,,percent of total billed charges,24.48% of total billed charges ,370.4,26.86,,,percent of total billed charges,26.86% of total billed charges,330.96,24,,,percent of total billed charges,24% of total billed charges ,430.25,31.2,,,percent of total billed charges,31.2% of total billed charges,1103.2,80,,,percent of total billed charges,80% of total billed charges,330.96,24,,,percent of total billed charges,24% of total billed charges ,330.96,24,,,percent of total billed charges,24% of total billed charges ,330.96,1103.2,
COLONOSCOPY FLEXIBLE W/ CONTROL OF BLEED,1445382,CDM,360,RC,45382,HCPCS,Outpatient,,,1421.5,710.75,,381.81,26.86,,,percent of total billed charges,26.86% of total billed charges,1066.13,75,,,percent of total billed charges,75% of total billed charges ,1066.13,75,,,percent of total billed charges,75% of total billed charges ,341.16,24,,,percent of total billed charges,24% of total billed charges ,1066.13,75,,,percent of total billed charges,75% of total billed charges ,1066.13,75,,,percent of total billed charges,75% of total billed charges ,1137.2,80,,,percent of total billed charges,80% of total billed charges ,344.57,24.24,,,percent of total billed charges,24.24% of total billed charges ,716.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,1066.13,75,,,percent of total billed charges,75% of total billed charges ,347.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,381.81,26.86,,,percent of total billed charges,26.86% of total billed charges,341.16,24,,,percent of total billed charges,24% of total billed charges ,443.51,31.2,,,percent of total billed charges,31.2% of total billed charges,1137.2,80,,,percent of total billed charges,80% of total billed charges,341.16,24,,,percent of total billed charges,24% of total billed charges ,341.16,24,,,percent of total billed charges,24% of total billed charges ,341.16,1137.2,
COLONOSCOPY FLEXIBLE TO SPLENIC FLEXURE,1445383,CDM,360,RC,45388,HCPCS,Outpatient,,,1511,755.5,,405.85,26.86,,,percent of total billed charges,26.86% of total billed charges,1133.25,75,,,percent of total billed charges,75% of total billed charges ,1133.25,75,,,percent of total billed charges,75% of total billed charges ,362.64,24,,,percent of total billed charges,24% of total billed charges ,1133.25,75,,,percent of total billed charges,75% of total billed charges ,1133.25,75,,,percent of total billed charges,75% of total billed charges ,1208.8,80,,,percent of total billed charges,80% of total billed charges ,366.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,761.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,1133.25,75,,,percent of total billed charges,75% of total billed charges ,369.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,405.85,26.86,,,percent of total billed charges,26.86% of total billed charges,362.64,24,,,percent of total billed charges,24% of total billed charges ,471.43,31.2,,,percent of total billed charges,31.2% of total billed charges,1208.8,80,,,percent of total billed charges,80% of total billed charges,362.64,24,,,percent of total billed charges,24% of total billed charges ,362.64,24,,,percent of total billed charges,24% of total billed charges ,362.64,1208.8,
COLONOSCOPY W/BIOPSY BY HOT BIOSPY FORCE,1445384,CDM,360,RC,45384,HCPCS,Outpatient,,,1577,788.5,,423.58,26.86,,,percent of total billed charges,26.86% of total billed charges,1182.75,75,,,percent of total billed charges,75% of total billed charges ,1182.75,75,,,percent of total billed charges,75% of total billed charges ,378.48,24,,,percent of total billed charges,24% of total billed charges ,1182.75,75,,,percent of total billed charges,75% of total billed charges ,1182.75,75,,,percent of total billed charges,75% of total billed charges ,1261.6,80,,,percent of total billed charges,80% of total billed charges ,382.26,24.24,,,percent of total billed charges,24.24% of total billed charges ,794.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,1182.75,75,,,percent of total billed charges,75% of total billed charges ,386.05,24.48,,,percent of total billed charges,24.48% of total billed charges ,423.58,26.86,,,percent of total billed charges,26.86% of total billed charges,378.48,24,,,percent of total billed charges,24% of total billed charges ,492.02,31.2,,,percent of total billed charges,31.2% of total billed charges,1261.6,80,,,percent of total billed charges,80% of total billed charges,378.48,24,,,percent of total billed charges,24% of total billed charges ,378.48,24,,,percent of total billed charges,24% of total billed charges ,378.48,1261.6,
COLONOSCOPY W/BIOPSY SNARE,1445385,CDM,360,RC,45385,HCPCS,Outpatient,,,1577,788.5,,423.58,26.86,,,percent of total billed charges,26.86% of total billed charges,1182.75,75,,,percent of total billed charges,75% of total billed charges ,1182.75,75,,,percent of total billed charges,75% of total billed charges ,378.48,24,,,percent of total billed charges,24% of total billed charges ,1182.75,75,,,percent of total billed charges,75% of total billed charges ,1182.75,75,,,percent of total billed charges,75% of total billed charges ,1261.6,80,,,percent of total billed charges,80% of total billed charges ,382.26,24.24,,,percent of total billed charges,24.24% of total billed charges ,794.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,1182.75,75,,,percent of total billed charges,75% of total billed charges ,386.05,24.48,,,percent of total billed charges,24.48% of total billed charges ,423.58,26.86,,,percent of total billed charges,26.86% of total billed charges,378.48,24,,,percent of total billed charges,24% of total billed charges ,492.02,31.2,,,percent of total billed charges,31.2% of total billed charges,1261.6,80,,,percent of total billed charges,80% of total billed charges,378.48,24,,,percent of total billed charges,24% of total billed charges ,378.48,24,,,percent of total billed charges,24% of total billed charges ,378.48,1261.6,
COLONOSCOPY W/ DILATION BY BALLOON 1 OR,1445386,CDM,360,RC,45386,HCPCS,Outpatient,,,1236,618,,331.99,26.86,,,percent of total billed charges,26.86% of total billed charges,927,75,,,percent of total billed charges,75% of total billed charges ,927,75,,,percent of total billed charges,75% of total billed charges ,296.64,24,,,percent of total billed charges,24% of total billed charges ,927,75,,,percent of total billed charges,75% of total billed charges ,927,75,,,percent of total billed charges,75% of total billed charges ,988.8,80,,,percent of total billed charges,80% of total billed charges ,299.61,24.24,,,percent of total billed charges,24.24% of total billed charges ,622.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,927,75,,,percent of total billed charges,75% of total billed charges ,302.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,331.99,26.86,,,percent of total billed charges,26.86% of total billed charges,296.64,24,,,percent of total billed charges,24% of total billed charges ,385.63,31.2,,,percent of total billed charges,31.2% of total billed charges,988.8,80,,,percent of total billed charges,80% of total billed charges,296.64,24,,,percent of total billed charges,24% of total billed charges ,296.64,24,,,percent of total billed charges,24% of total billed charges ,296.64,988.8,
SIGMOIDOSCOPY FLEX W/ BIOPSY SINGLE OR M,1445531,CDM,521,RC,45531,HCPCS,Outpatient,,,509,254.5,,136.72,26.86,,,percent of total billed charges,26.86% of total billed charges,381.75,75,,,percent of total billed charges,75% of total billed charges ,381.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,381.75,75,,,percent of total billed charges,75% of total billed charges ,381.75,75,,,percent of total billed charges,75% of total billed charges ,407.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,256.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,381.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,136.72,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,136.72,407.2,
INCISION AND DRAINAGE OF ISCHIORECTAL/PE,1446040,CDM,521,RC,46040,HCPCS,Outpatient,,,2137.5,1068.75,,574.13,26.86,,,percent of total billed charges,26.86% of total billed charges,1603.13,75,,,percent of total billed charges,75% of total billed charges ,1603.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1603.13,75,,,percent of total billed charges,75% of total billed charges ,1603.13,75,,,percent of total billed charges,75% of total billed charges ,1710,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1077.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,1603.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,574.13,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1710,
INCISION OF THROMBOSED HEMORRHOID EXTERN,1446083,CDM,521,RC,46083,HCPCS,Outpatient,,,373,186.5,,100.19,26.86,,,percent of total billed charges,26.86% of total billed charges,279.75,75,,,percent of total billed charges,75% of total billed charges ,279.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,279.75,75,,,percent of total billed charges,75% of total billed charges ,279.75,75,,,percent of total billed charges,75% of total billed charges ,298.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,187.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,279.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,100.19,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,100.19,298.4,
FISSURECTOMY INCLUDING SPHINCTEROTOMY,1446200,CDM,521,RC,46200,HCPCS,Outpatient,,,1352.5,676.25,,363.28,26.86,,,percent of total billed charges,26.86% of total billed charges,1014.38,75,,,percent of total billed charges,75% of total billed charges ,1014.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1014.38,75,,,percent of total billed charges,75% of total billed charges ,1014.38,75,,,percent of total billed charges,75% of total billed charges ,1082,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,681.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,1014.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,363.28,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1082,
HEMORRHOIDECTOMY INTERNAL BY RUBBER BAND,1446221,CDM,521,RC,46221,HCPCS,Outpatient,,,579,289.5,,155.52,26.86,,,percent of total billed charges,26.86% of total billed charges,434.25,75,,,percent of total billed charges,75% of total billed charges ,434.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,434.25,75,,,percent of total billed charges,75% of total billed charges ,434.25,75,,,percent of total billed charges,75% of total billed charges ,463.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,291.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,434.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,155.52,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,155.52,463.2,
HEMORROIDECTOMY COMPLEX,1446260,CDM,521,RC,46260,HCPCS,Outpatient,,,2414.5,1207.25,,648.53,26.86,,,percent of total billed charges,26.86% of total billed charges,1810.88,75,,,percent of total billed charges,75% of total billed charges ,1810.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1810.88,75,,,percent of total billed charges,75% of total billed charges ,1810.88,75,,,percent of total billed charges,75% of total billed charges ,1931.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1216.91,50.4,,,percent of total billed charges,50.4% of total billed charges ,1810.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,648.53,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1931.6,
SURGICAL TREATMENT OF ANAL FISTULA,1446270,CDM,360,RC,46270,HCPCS,Outpatient,,,1593.5,796.75,,428.01,26.86,,,percent of total billed charges,26.86% of total billed charges,1195.13,75,,,percent of total billed charges,75% of total billed charges ,1195.13,75,,,percent of total billed charges,75% of total billed charges ,382.44,24,,,percent of total billed charges,24% of total billed charges ,1195.13,75,,,percent of total billed charges,75% of total billed charges ,1195.13,75,,,percent of total billed charges,75% of total billed charges ,1274.8,80,,,percent of total billed charges,80% of total billed charges ,386.26,24.24,,,percent of total billed charges,24.24% of total billed charges ,803.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,1195.13,75,,,percent of total billed charges,75% of total billed charges ,390.09,24.48,,,percent of total billed charges,24.48% of total billed charges ,428.01,26.86,,,percent of total billed charges,26.86% of total billed charges,382.44,24,,,percent of total billed charges,24% of total billed charges ,497.17,31.2,,,percent of total billed charges,31.2% of total billed charges,1274.8,80,,,percent of total billed charges,80% of total billed charges,382.44,24,,,percent of total billed charges,24% of total billed charges ,382.44,24,,,percent of total billed charges,24% of total billed charges ,382.44,1274.8,
EXCISION OF THROMBOSED HEMORRHOID EXTERN,1446320,CDM,521,RC,46320,HCPCS,Outpatient,,,483,241.5,,129.73,26.86,,,percent of total billed charges,26.86% of total billed charges,362.25,75,,,percent of total billed charges,75% of total billed charges ,362.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,362.25,75,,,percent of total billed charges,75% of total billed charges ,362.25,75,,,percent of total billed charges,75% of total billed charges ,386.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,243.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,362.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,129.73,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,129.73,386.4,
ANOSCOPY DX W OR W/OUT SPECIMEN COLLECTI,1446600,CDM,521,RC,46600,HCPCS,Outpatient,,,216.5,108.25,,58.15,26.86,,,percent of total billed charges,26.86% of total billed charges,162.38,75,,,percent of total billed charges,75% of total billed charges ,162.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,162.38,75,,,percent of total billed charges,75% of total billed charges ,162.38,75,,,percent of total billed charges,75% of total billed charges ,173.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,109.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,162.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,58.15,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,58.15,241.16,
DESTRUCTION OF LESION ANUS SIMPLE CHEMIC,1446900,CDM,521,RC,46900,HCPCS,Outpatient,,,644,322,,172.98,26.86,,,percent of total billed charges,26.86% of total billed charges,483,75,,,percent of total billed charges,75% of total billed charges ,483,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,483,75,,,percent of total billed charges,75% of total billed charges ,483,75,,,percent of total billed charges,75% of total billed charges ,515.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,324.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,483,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,172.98,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,172.98,515.2,
DESTRUCTION OF LESION ANUS SIMPLE SURGIC,1446922,CDM,521,RC,46922,HCPCS,Outpatient,,,1153.5,576.75,,309.83,26.86,,,percent of total billed charges,26.86% of total billed charges,865.13,75,,,percent of total billed charges,75% of total billed charges ,865.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,865.13,75,,,percent of total billed charges,75% of total billed charges ,865.13,75,,,percent of total billed charges,75% of total billed charges ,922.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,581.36,50.4,,,percent of total billed charges,50.4% of total billed charges ,865.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,309.83,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,922.8,
DESTR OF LES ANUS EXTENSIVE (EX LASER SU,1446924,CDM,521,RC,46924,HCPCS,Outpatient,,,2135,1067.5,,573.46,26.86,,,percent of total billed charges,26.86% of total billed charges,1601.25,75,,,percent of total billed charges,75% of total billed charges ,1601.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1601.25,75,,,percent of total billed charges,75% of total billed charges ,1601.25,75,,,percent of total billed charges,75% of total billed charges ,1708,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1076.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,1601.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,573.46,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1708,
HEMORRHOIDOPEXY BY STAPLING,1446947,CDM,521,RC,46947,HCPCS,Outpatient,,,1287.5,643.75,,345.82,26.86,,,percent of total billed charges,26.86% of total billed charges,965.63,75,,,percent of total billed charges,75% of total billed charges ,965.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,965.63,75,,,percent of total billed charges,75% of total billed charges ,965.63,75,,,percent of total billed charges,75% of total billed charges ,1030,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,648.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,965.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,345.82,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1030,
CHOLECYSTECTOMY LAPARASCOPIC,1447562,CDM,521,RC,47562,HCPCS,Outpatient,,,3313.5,1656.75,,890.01,26.86,,,percent of total billed charges,26.86% of total billed charges,2485.13,75,,,percent of total billed charges,75% of total billed charges ,2485.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,2485.13,75,,,percent of total billed charges,75% of total billed charges ,2485.13,75,,,percent of total billed charges,75% of total billed charges ,2650.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1670,50.4,,,percent of total billed charges,50.4% of total billed charges ,2485.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,890.01,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,2650.8,
CHOLECYSTECTOMY W/ CHOLANGIOGRAM,1447563,CDM,521,RC,47563,HCPCS,Outpatient,,,3534,1767,,949.23,26.86,,,percent of total billed charges,26.86% of total billed charges,2650.5,75,,,percent of total billed charges,75% of total billed charges ,2650.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,2650.5,75,,,percent of total billed charges,75% of total billed charges ,2650.5,75,,,percent of total billed charges,75% of total billed charges ,2827.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1781.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,2650.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,949.23,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,2827.2,
CHOLECYSTECTOMY OPEN,1447600,CDM,521,RC,47600,HCPCS,Outpatient,,,3313.5,1656.75,,890.01,26.86,,,percent of total billed charges,26.86% of total billed charges,2485.13,75,,,percent of total billed charges,75% of total billed charges ,2485.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,2485.13,75,,,percent of total billed charges,75% of total billed charges ,2485.13,75,,,percent of total billed charges,75% of total billed charges ,2650.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1670,50.4,,,percent of total billed charges,50.4% of total billed charges ,2485.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,890.01,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,2650.8,
CHOLECYSTECTOMY W/ CHOLANGIOGRAPHY,1447605,CDM,521,RC,47605,HCPCS,Outpatient,,,3534,1767,,949.23,26.86,,,percent of total billed charges,26.86% of total billed charges,2650.5,75,,,percent of total billed charges,75% of total billed charges ,2650.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,2650.5,75,,,percent of total billed charges,75% of total billed charges ,2650.5,75,,,percent of total billed charges,75% of total billed charges ,2827.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1781.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,2650.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,949.23,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,2827.2,
REPAIR INITIAL INGUINAL HERNIA AGE 5 YEA,1449505,CDM,521,RC,49505,HCPCS,Outpatient,,,1928,964,,517.86,26.86,,,percent of total billed charges,26.86% of total billed charges,1446,75,,,percent of total billed charges,75% of total billed charges ,1446,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1446,75,,,percent of total billed charges,75% of total billed charges ,1446,75,,,percent of total billed charges,75% of total billed charges ,1542.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,971.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,1446,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,517.86,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1542.4,
REPAIR INITIAL INCISIONAL OF VENTRAL HER,1449560,CDM,521,RC,49560,HCPCS,Outpatient,,,2555.5,1277.75,,686.41,26.86,,,percent of total billed charges,26.86% of total billed charges,1916.63,75,,,percent of total billed charges,75% of total billed charges ,1916.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1916.63,75,,,percent of total billed charges,75% of total billed charges ,1916.63,75,,,percent of total billed charges,75% of total billed charges ,2044.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1287.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,1916.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,686.41,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,2044.4,
REPAIR RECURRENT INCISIONAL OR VENTRAL H,1449565,CDM,521,RC,49565,HCPCS,Outpatient,,,2789,1394.5,,749.13,26.86,,,percent of total billed charges,26.86% of total billed charges,2091.75,75,,,percent of total billed charges,75% of total billed charges ,2091.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,2091.75,75,,,percent of total billed charges,75% of total billed charges ,2091.75,75,,,percent of total billed charges,75% of total billed charges ,2231.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1405.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,2091.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,749.13,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,2231.2,
IMPLANTATION OF MESH/W INCISIONAL HERNIA,1449568,CDM,521,RC,49568,HCPCS,Outpatient,,,929,464.5,,249.53,26.86,,,percent of total billed charges,26.86% of total billed charges,696.75,75,,,percent of total billed charges,75% of total billed charges ,696.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,696.75,75,,,percent of total billed charges,75% of total billed charges ,696.75,75,,,percent of total billed charges,75% of total billed charges ,743.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,468.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,696.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,249.53,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,743.2,
REPAIR UMBILICAL HERNIA AGE 5 YRS OR OLD,1449585,CDM,521,RC,49585,HCPCS,Outpatient,,,1999,999.5,,536.93,26.86,,,percent of total billed charges,26.86% of total billed charges,1499.25,75,,,percent of total billed charges,75% of total billed charges ,1499.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1499.25,75,,,percent of total billed charges,75% of total billed charges ,1499.25,75,,,percent of total billed charges,75% of total billed charges ,1599.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1007.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,1499.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,536.93,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1599.2,
INCARCERATED UMBILICAL HERNIA,1449587,CDM,521,RC,49587,HCPCS,Outpatient,,,2231,1115.5,,599.25,26.86,,,percent of total billed charges,26.86% of total billed charges,1673.25,75,,,percent of total billed charges,75% of total billed charges ,1673.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1673.25,75,,,percent of total billed charges,75% of total billed charges ,1673.25,75,,,percent of total billed charges,75% of total billed charges ,1784.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1124.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,1673.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,599.25,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1784.8,
I & D OF VULVA AND PERINEAL ABSCESS,1456405,CDM,521,RC,56405,HCPCS,Outpatient,,,450,225,,120.87,26.86,,,percent of total billed charges,26.86% of total billed charges,337.5,75,,,percent of total billed charges,75% of total billed charges ,337.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,337.5,75,,,percent of total billed charges,75% of total billed charges ,337.5,75,,,percent of total billed charges,75% of total billed charges ,360,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,226.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,337.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,120.87,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,120.87,360,
PARTIAL REMOVAL OF THYROID,1460220,CDM,360,RC,60220,HCPCS,Outpatient,,,1847,923.5,,496.1,26.86,,,percent of total billed charges,26.86% of total billed charges,1385.25,75,,,percent of total billed charges,75% of total billed charges ,1385.25,75,,,percent of total billed charges,75% of total billed charges ,443.28,24,,,percent of total billed charges,24% of total billed charges ,1385.25,75,,,percent of total billed charges,75% of total billed charges ,1385.25,75,,,percent of total billed charges,75% of total billed charges ,1477.6,80,,,percent of total billed charges,80% of total billed charges ,447.71,24.24,,,percent of total billed charges,24.24% of total billed charges ,930.89,50.4,,,percent of total billed charges,50.4% of total billed charges ,1385.25,75,,,percent of total billed charges,75% of total billed charges ,452.15,24.48,,,percent of total billed charges,24.48% of total billed charges ,496.1,26.86,,,percent of total billed charges,26.86% of total billed charges,443.28,24,,,percent of total billed charges,24% of total billed charges ,576.26,31.2,,,percent of total billed charges,31.2% of total billed charges,1477.6,80,,,percent of total billed charges,80% of total billed charges,443.28,24,,,percent of total billed charges,24% of total billed charges ,443.28,24,,,percent of total billed charges,24% of total billed charges ,443.28,1477.6,
INJECTION ANESTHETIC AGENT SPINAL ACCESS,1464412,CDM,521,RC,64999,HCPCS,Outpatient,,,775.5,387.75,,208.3,26.86,,,percent of total billed charges,26.86% of total billed charges,581.63,75,,,percent of total billed charges,75% of total billed charges ,581.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,581.63,75,,,percent of total billed charges,75% of total billed charges ,581.63,75,,,percent of total billed charges,75% of total billed charges ,620.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,390.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,581.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,208.3,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,620.4,
INJECTION ANESTHETIC AGENT CERVICAL REGI,1464413,CDM,521,RC,64999,HCPCS,Outpatient,,,688,344,,184.8,26.86,,,percent of total billed charges,26.86% of total billed charges,516,75,,,percent of total billed charges,75% of total billed charges ,516,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,516,75,,,percent of total billed charges,75% of total billed charges ,516,75,,,percent of total billed charges,75% of total billed charges ,550.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,346.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,516,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,184.8,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,184.8,550.4,
LUMBAR INJECTION ANESTHETIC AGEN SCIATIC,1464445,CDM,521,RC,64445,HCPCS,Outpatient,,,688,344,,184.8,26.86,,,percent of total billed charges,26.86% of total billed charges,516,75,,,percent of total billed charges,75% of total billed charges ,516,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,516,75,,,percent of total billed charges,75% of total billed charges ,516,75,,,percent of total billed charges,75% of total billed charges ,550.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,346.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,516,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,184.8,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,184.8,550.4,
REMOVAL OF FOREIGN BODY EXTERNAL EYE COR,1465220,CDM,521,RC,65220,HCPCS,Outpatient,,,373,186.5,,100.19,26.86,,,percent of total billed charges,26.86% of total billed charges,279.75,75,,,percent of total billed charges,75% of total billed charges ,279.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,279.75,75,,,percent of total billed charges,75% of total billed charges ,279.75,75,,,percent of total billed charges,75% of total billed charges ,298.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,187.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,279.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,100.19,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,100.19,298.4,
EAR IRRIGATION (RMVL IMPACTED WAX),1469210,CDM,521,RC,69210,HCPCS,Outpatient,,,135,67.5,,36.26,26.86,,,percent of total billed charges,26.86% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges ,101.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,101.25,75,,,percent of total billed charges,75% of total billed charges ,101.25,75,,,percent of total billed charges,75% of total billed charges ,108,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,68.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,101.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,36.26,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,36.26,241.16,
INTRALUM DILAT STRICTURES AND/OR OBSTRUC,1474360,CDM,521,RC,74360,HCPCS,Outpatient,,,215.5,107.75,,57.88,26.86,,,percent of total billed charges,26.86% of total billed charges,161.63,75,,,percent of total billed charges,75% of total billed charges ,161.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,161.63,75,,,percent of total billed charges,75% of total billed charges ,161.63,75,,,percent of total billed charges,75% of total billed charges ,172.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,108.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,161.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,57.88,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,57.88,241.16,
KIDNEY IMAGING SINGLE STUDY WITH PHARMAC,1478708,CDM,521,RC,78708,HCPCS,Outpatient,,,1129,564.5,,303.25,26.86,,,percent of total billed charges,26.86% of total billed charges,846.75,75,,,percent of total billed charges,75% of total billed charges ,846.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,846.75,75,,,percent of total billed charges,75% of total billed charges ,846.75,75,,,percent of total billed charges,75% of total billed charges ,903.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,569.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,846.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,303.25,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,903.2,
.......COMPREHENSIVE METABOLIC PANEL,1480053,CDM,301,RC,,,Outpatient,,,61,30.5,,16.38,26.86,,,percent of total billed charges,26.86% of total billed charges,45.75,75,,,percent of total billed charges,75% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,14.64,24,,,percent of total billed charges,24% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,48.8,80,,,percent of total billed charges,80% of total billed charges ,14.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,30.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,14.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.38,26.86,,,percent of total billed charges,26.86% of total billed charges,14.64,24,,,percent of total billed charges,24% of total billed charges ,19.03,31.2,,,percent of total billed charges,31.2% of total billed charges,48.8,80,,,percent of total billed charges,80% of total billed charges,14.64,24,,,percent of total billed charges,24% of total billed charges ,14.64,24,,,percent of total billed charges,24% of total billed charges ,14.64,48.8,
LIPID PANEL,1480061,CDM,521,RC,80061,HCPCS,Outpatient,,,70,35,,16.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,52.5,75,,,percent of total billed charges,75% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,52.5,75,,,percent of total billed charges,75% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,56,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,35.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,16.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,16.85,241.16,
DRUG SCREEN QUALITATIVE,1480100,CDM,521,RC,80375,HCPCS,Outpatient,,,135,67.5,,18.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,108,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,68.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,101.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,18.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,18.25,241.16,
URINALYSIS BY DIPSTICK OR TABLET REAGENT,1481001,CDM,307,RC,81001,HCPCS,Outpatient,,,31,15.5,,3.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,3.99,24.8,
URINALYIS BY DIPSTICK OR TABLE NON-AUTOM,1481002,CDM,521,RC,81002,HCPCS,Outpatient,,,24,12,,3.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18,75,,,percent of total billed charges,75% of total billed charges ,18,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,18,75,,,percent of total billed charges,75% of total billed charges ,18,75,,,percent of total billed charges,75% of total billed charges ,19.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,12.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,18,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,3.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,3.21,241.16,
URINALYSIS DIP STICK/TABLET RGNT/AUTO W/,1481003,CDM,521,RC,81003,HCPCS,Outpatient,,,25,12.5,,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.75,75,,,percent of total billed charges,75% of total billed charges ,18.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,18.75,75,,,percent of total billed charges,75% of total billed charges ,18.75,75,,,percent of total billed charges,75% of total billed charges ,20,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,12.6,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,2.83,241.16,
MICROALBUMIN-QUANTITATIVE,1482043,CDM,521,RC,82043,HCPCS,Outpatient,,,64,32,,7.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,7.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,7.28,241.16,
BLOOD OCCULT PERFORMED FOR OTHER THAN CO,1482272,CDM,521,RC,82272,HCPCS,Outpatient,,,23,11.5,,4.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.25,75,,,percent of total billed charges,75% of total billed charges ,17.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,17.25,75,,,percent of total billed charges,75% of total billed charges ,17.25,75,,,percent of total billed charges,75% of total billed charges ,18.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,11.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,17.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,4.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,4.04,241.16,
CREATININE OTHER SOURCE,1482570,CDM,521,RC,82570,HCPCS,Outpatient,,,33,16.5,,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,6.51,241.16,
HEMOGLOBIN A1C,1483036,CDM,521,RC,83036,HCPCS,Outpatient,,,68,34,,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51,75,,,percent of total billed charges,75% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,51,75,,,percent of total billed charges,75% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,54.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,34.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,12.2,241.16,
PROSTATE SPECIFIC ANTIGEN-PSA TOTAL,1484153,CDM,521,RC,84153,HCPCS,Outpatient,,,107,53.5,,23.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,53.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,23.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,23.13,241.16,
THYROXINE TOTAL,1484436,CDM,521,RC,84436,HCPCS,Outpatient,,,39,19.5,,8.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,19.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,8.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,8.65,241.16,
THYROID STIMULATING HORMONE,1484443,CDM,521,RC,84443,HCPCS,Outpatient,,,97,48.5,,21.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,72.75,75,,,percent of total billed charges,75% of total billed charges ,72.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,72.75,75,,,percent of total billed charges,75% of total billed charges ,72.75,75,,,percent of total billed charges,75% of total billed charges ,77.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,48.89,50.4,,,percent of total billed charges,50.4% of total billed charges ,72.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,21.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,21.12,241.16,
TRANSFERASE ALANINE AMINO (ALT)(SGPT),1484460,CDM,521,RC,84460,HCPCS,Outpatient,,,27,13.5,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,6.35,241.16,
HCG QUALITATIVE,1484703,CDM,521,RC,84703,HCPCS,Outpatient,,,71,35.5,,8.07,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,53.25,75,,,percent of total billed charges,75% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,53.25,75,,,percent of total billed charges,75% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,56.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,35.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,8.07,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,8.07,241.16,
HEMOGLOBIN (HGB),1485018,CDM,300,RC,85018,HCPCS,Outpatient,,,19,9.5,,2.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.25,75,,,percent of total billed charges,75% of total billed charges ,14.25,75,,,percent of total billed charges,75% of total billed charges ,4.56,24,,,percent of total billed charges,24% of total billed charges ,14.25,75,,,percent of total billed charges,75% of total billed charges ,14.25,75,,,percent of total billed charges,75% of total billed charges ,15.2,80,,,percent of total billed charges,80% of total billed charges ,4.61,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.25,75,,,percent of total billed charges,75% of total billed charges ,4.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.56,24,,,percent of total billed charges,24% of total billed charges ,5.93,31.2,,,percent of total billed charges,31.2% of total billed charges,15.2,80,,,percent of total billed charges,80% of total billed charges,4.56,24,,,percent of total billed charges,24% of total billed charges ,4.56,24,,,percent of total billed charges,24% of total billed charges ,2.98,15.2,
CBC,1485025,CDM,300,RC,85025,HCPCS,Outpatient,,,39,19.5,,9.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.25,75,,,percent of total billed charges,75% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,9.36,24,,,percent of total billed charges,24% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,31.2,80,,,percent of total billed charges,80% of total billed charges ,9.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,9.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.36,24,,,percent of total billed charges,24% of total billed charges ,12.17,31.2,,,percent of total billed charges,31.2% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,9.36,24,,,percent of total billed charges,24% of total billed charges ,9.36,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,
PROTHROMBIN TIME (PT),1485610,CDM,521,RC,85610,HCPCS,Outpatient,,,27,13.5,,4.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,4.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,4.94,241.16,
SKN TEST-PPD,1486580,CDM,521,RC,86580,HCPCS,Outpatient,,,35,17.5,,8.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,28,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,17.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,8.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,8.13,241.16,
CULTURE BACTERIAL ANY OTHER SOURCE EXCEP,1487070,CDM,521,RC,87070,HCPCS,Outpatient,,,40,20,,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,20.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,10.83,241.16,
WET PREP-SMR PRIM SRC WET MOUNT NFCT AGT,1487210,CDM,521,RC,87210,HCPCS,Outpatient,,,27,13.5,,5.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,5.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,5.36,241.16,
STREP GROUP A,1487430,CDM,521,RC,87430,HCPCS,Outpatient,,,43.5,21.75,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,34.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,21.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,15.08,241.16,
RAPID STREPT A,1487880,CDM,521,RC,87880,HCPCS,Outpatient,,,54,27,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.5,75,,,percent of total billed charges,75% of total billed charges ,40.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,40.5,75,,,percent of total billed charges,75% of total billed charges ,40.5,75,,,percent of total billed charges,75% of total billed charges ,43.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,27.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,15.08,241.16,
PAP SMEAR-CYTOPATHOLOGY SLIDES CERVICAL,1488150,CDM,521,RC,88150,HCPCS,Outpatient,,,84.5,42.25,,13.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,67.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,42.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,13.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,13.28,241.16,
IMMUNIZATION ADMINISTRATION THROUGH 18 Y,1490460,CDM,521,RC,90460,HCPCS,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,13.83,241.16,
H1N1 VACCINATION,1490470,CDM,521,RC,90471,HCPCS,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,13.83,241.16,
VACCINE ADMINISTRATION FIRST SHOT,1490471,CDM,521,RC,90471,HCPCS,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,13.83,241.16,
VACCINE ADMINISTRATION EACH ADDITIONAL,1490472,CDM,521,RC,90472,HCPCS,Outpatient,,,28,14,,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,22.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,14.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,7.52,241.16,
GARDASIL HPV VACCINE,1490649,CDM,521,RC,90649,HCPCS,Outpatient,,,298.5,149.25,,80.18,26.86,,,percent of total billed charges,26.86% of total billed charges,223.88,75,,,percent of total billed charges,75% of total billed charges ,223.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,223.88,75,,,percent of total billed charges,75% of total billed charges ,223.88,75,,,percent of total billed charges,75% of total billed charges ,238.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,150.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,80.18,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,80.18,241.16,
INFLUENZA VACCINE PRESERVATIVE FREE,1490656,CDM,521,RC,90656,HCPCS,Outpatient,,,35,17.5,,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,28,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,17.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,9.4,241.16,
INFLUENZA VACCINE AGE 3 YRS +,1490658,CDM,521,RC,90658,HCPCS,Outpatient,,,36,18,,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,28.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,18.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,9.67,241.16,
INFLUENZA VIRUS VACCINE SPLIT VIRUS ENHA,1490662,CDM,521,RC,90662,HCPCS,Outpatient,,,84.5,42.25,,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.38,75,,,percent of total billed charges,75% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,63.38,75,,,percent of total billed charges,75% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,67.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,42.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,42.59,241.16,
DIPHTHERIA TETANUS TOXOIDS/PERTUSSIS VAC,1490700,CDM,521,RC,90700,HCPCS,Outpatient,,,59.5,29.75,,15.98,26.86,,,percent of total billed charges,26.86% of total billed charges,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,47.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,15.98,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,15.98,241.16,
DIPHTERIA TETANUS TOXOIDS (DT) ADMINISTR,1490702,CDM,521,RC,90702,HCPCS,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,12.76,241.16,
TETANUS SHOT,1490703,CDM,521,RC,90714,HCPCS,Outpatient,,,50.5,25.25,,30.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,37.88,75,,,percent of total billed charges,75% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,37.88,75,,,percent of total billed charges,75% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,40.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,25.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,30.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,25.45,241.16,
TDAP > 7YRS IM,1490715,CDM,521,RC,90715,HCPCS,Outpatient,,,38,19,,38.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,38.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,19.15,241.16,
TETANUS/DIPHTHERIA TOXOIDS (TD) ADM PT 7,1490718,CDM,521,RC,90714,HCPCS,Outpatient,,,46.5,23.25,,30.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,30.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,23.44,241.16,
PNEUMOCOCCAL VACCINE AGE 2YRS+,1490732,CDM,521,RC,90732,HCPCS,Outpatient,,,76,38,,133.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,57,75,,,percent of total billed charges,75% of total billed charges ,57,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,57,75,,,percent of total billed charges,75% of total billed charges ,57,75,,,percent of total billed charges,75% of total billed charges ,60.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,38.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,57,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,133.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,38.3,241.16,
ZOSTER SHINGLES VACCINE LIVE SUBCUTANEOU,1490736,CDM,521,RC,90736,HCPCS,Outpatient,,,378,189,,101.53,26.86,,,percent of total billed charges,26.86% of total billed charges,283.5,75,,,percent of total billed charges,75% of total billed charges ,283.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,283.5,75,,,percent of total billed charges,75% of total billed charges ,283.5,75,,,percent of total billed charges,75% of total billed charges ,302.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,190.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,283.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,101.53,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,101.53,302.4,
GI TRACT IMAGING INTRALUMAL ESOPH THROUG,1491110,CDM,521,RC,91110,HCPCS,Outpatient,,,2235,1117.5,,600.32,26.86,,,percent of total billed charges,26.86% of total billed charges,1676.25,75,,,percent of total billed charges,75% of total billed charges ,1676.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1676.25,75,,,percent of total billed charges,75% of total billed charges ,1676.25,75,,,percent of total billed charges,75% of total billed charges ,1788,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1126.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,1676.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,600.32,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1788,
HEARING TEST-PURE TONE ADIOMETRY AIR ONL,1492552,CDM,521,RC,92552,HCPCS,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,13.83,241.16,
EKG-ECG ROUTINE ECG W/AT LEAST 12 LDS W,1493000,CDM,521,RC,93000,HCPCS,Outpatient,,,107,53.5,,28.74,26.86,,,percent of total billed charges,26.86% of total billed charges,80.25,75,,,percent of total billed charges,75% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,80.25,75,,,percent of total billed charges,75% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,85.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,53.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,28.74,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,28.74,241.16,
EVENT MONITORING/RECORDING,1493230,CDM,731,RC,93270,HCPCS,Outpatient,,,798.5,399.25,,214.48,26.86,,,percent of total billed charges,26.86% of total billed charges,598.88,75,,,percent of total billed charges,75% of total billed charges ,598.88,75,,,percent of total billed charges,75% of total billed charges ,191.64,24,,,percent of total billed charges,24% of total billed charges ,598.88,75,,,percent of total billed charges,75% of total billed charges ,598.88,75,,,percent of total billed charges,75% of total billed charges ,638.8,80,,,percent of total billed charges,80% of total billed charges ,193.56,24.24,,,percent of total billed charges,24.24% of total billed charges ,402.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,598.88,75,,,percent of total billed charges,75% of total billed charges ,195.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,214.48,26.86,,,percent of total billed charges,26.86% of total billed charges,191.64,24,,,percent of total billed charges,24% of total billed charges ,249.13,31.2,,,percent of total billed charges,31.2% of total billed charges,638.8,80,,,percent of total billed charges,80% of total billed charges,191.64,24,,,percent of total billed charges,24% of total billed charges ,191.64,24,,,percent of total billed charges,24% of total billed charges ,191.64,638.8,
HOLTER MONITOR,1493233,CDM,731,RC,93224,HCPCS,Outpatient,,,182.5,91.25,,49.02,26.86,,,percent of total billed charges,26.86% of total billed charges,136.88,75,,,percent of total billed charges,75% of total billed charges ,136.88,75,,,percent of total billed charges,75% of total billed charges ,43.8,24,,,percent of total billed charges,24% of total billed charges ,136.88,75,,,percent of total billed charges,75% of total billed charges ,136.88,75,,,percent of total billed charges,75% of total billed charges ,146,80,,,percent of total billed charges,80% of total billed charges ,44.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,91.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,136.88,75,,,percent of total billed charges,75% of total billed charges ,44.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,49.02,26.86,,,percent of total billed charges,26.86% of total billed charges,43.8,24,,,percent of total billed charges,24% of total billed charges ,56.94,31.2,,,percent of total billed charges,31.2% of total billed charges,146,80,,,percent of total billed charges,80% of total billed charges,43.8,24,,,percent of total billed charges,24% of total billed charges ,43.8,24,,,percent of total billed charges,24% of total billed charges ,43.8,146,
HOLTER MONITOR 3 - 7 DAYS,1493235,CDM,731,RC,93242,HCPCS,Outpatient,,,372,186,,99.92,26.86,,,percent of total billed charges,26.86% of total billed charges,279,75,,,percent of total billed charges,75% of total billed charges ,279,75,,,percent of total billed charges,75% of total billed charges ,89.28,24,,,percent of total billed charges,24% of total billed charges ,279,75,,,percent of total billed charges,75% of total billed charges ,279,75,,,percent of total billed charges,75% of total billed charges ,297.6,80,,,percent of total billed charges,80% of total billed charges ,90.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,187.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,279,75,,,percent of total billed charges,75% of total billed charges ,91.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,99.92,26.86,,,percent of total billed charges,26.86% of total billed charges,89.28,24,,,percent of total billed charges,24% of total billed charges ,116.06,31.2,,,percent of total billed charges,31.2% of total billed charges,297.6,80,,,percent of total billed charges,80% of total billed charges,89.28,24,,,percent of total billed charges,24% of total billed charges ,89.28,24,,,percent of total billed charges,24% of total billed charges ,89.28,297.6,
HOLTER MONITOR 8 - 14 DAYS,1493250,CDM,731,RC,93246,HCPCS,Outpatient,,,424.5,212.25,,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,339.6,80,,,percent of total billed charges,80% of total billed charges ,102.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,213.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,103.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,132.44,31.2,,,percent of total billed charges,31.2% of total billed charges,339.6,80,,,percent of total billed charges,80% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,339.6,
INSERTION AND PLACEMENT OF FLOW DIRECTED,1493503,CDM,521,RC,93503,HCPCS,Outpatient,,,750,375,,201.45,26.86,,,percent of total billed charges,26.86% of total billed charges,562.5,75,,,percent of total billed charges,75% of total billed charges ,562.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,562.5,75,,,percent of total billed charges,75% of total billed charges ,562.5,75,,,percent of total billed charges,75% of total billed charges ,600,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,378,50.4,,,percent of total billed charges,50.4% of total billed charges ,562.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,201.45,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,600,
SPIROMETRY PLAIN,1494010,CDM,521,RC,94010,HCPCS,Outpatient,,,148.5,74.25,,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,118.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,74.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,39.89,241.16,
BREATHING TREATMENT-DEMONSTRATION AND/OR,1494664,CDM,410,RC,94664,HCPCS,Outpatient,,,73,36.5,,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,58.4,
PULSE OX-NONINVASIVE EAR OR PULSE OX FOR,1494760,CDM,521,RC,94760,HCPCS,Outpatient,,,43.5,21.75,,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,34.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,21.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,11.68,241.16,
ALLERGY SINGLE- PROFESSIONAL SERVICES FO,1495115,CDM,521,RC,95115,HCPCS,Outpatient,,,30,15,,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,24,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,15.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,8.06,241.16,
ALLERGY MULTIPLE- PROF SVS ALLERGY IMMUN,1495117,CDM,521,RC,95117,HCPCS,Outpatient,,,44.5,22.25,,11.95,26.86,,,percent of total billed charges,26.86% of total billed charges,33.38,75,,,percent of total billed charges,75% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,33.38,75,,,percent of total billed charges,75% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,35.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,22.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,11.95,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,11.95,241.16,
THERAPEUTIC PROPHYLACTIC INJECTION,1496372,CDM,521,RC,96372,HCPCS,Outpatient,,,53.5,26.75,,14.37,26.86,,,percent of total billed charges,26.86% of total billed charges,40.13,75,,,percent of total billed charges,75% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,40.13,75,,,percent of total billed charges,75% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,42.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,26.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,14.37,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,14.37,241.16,
NEG PRESS WOUND THER <= 50 SQ CM,1497605,CDM,521,RC,97605,HCPCS,Outpatient,,,216.5,108.25,,58.15,26.86,,,percent of total billed charges,26.86% of total billed charges,162.38,75,,,percent of total billed charges,75% of total billed charges ,162.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,162.38,75,,,percent of total billed charges,75% of total billed charges ,162.38,75,,,percent of total billed charges,75% of total billed charges ,173.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,109.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,162.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,58.15,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,58.15,241.16,
NEG PRESS WOUND THER >50 SQ CM,1497606,CDM,521,RC,97606,HCPCS,Outpatient,,,234,117,,62.85,26.86,,,percent of total billed charges,26.86% of total billed charges,175.5,75,,,percent of total billed charges,75% of total billed charges ,175.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,175.5,75,,,percent of total billed charges,75% of total billed charges ,175.5,75,,,percent of total billed charges,75% of total billed charges ,187.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,117.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,175.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,62.85,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,62.85,241.16,
POST OP,1499024,CDM,521,RC,99024,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,187.36,101,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,189.22,102,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,241.16,
EDUCATIONAL SUPPLIES AND HANDOUTS,1499071,CDM,521,RC,99071,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,187.36,101,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,189.22,102,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,241.16,
SPECIAL REPORTS MEDICAL RECORDS INSURANC,1499080,CDM,521,RC,99080,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,187.36,101,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,189.22,102,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,241.16,
VISUAL FUNCTION SCREENING,1499172,CDM,521,RC,99172,HCPCS,Outpatient,,,66,33,,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,52.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,33.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,17.73,241.16,
NEW PATIENT LEVEL 1 (10 MINS),1499201,CDM,521,RC,99202,HCPCS,Outpatient,,,132,66,,35.46,26.86,,,percent of total billed charges,26.86% of total billed charges,99,75,,,percent of total billed charges,75% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,99,75,,,percent of total billed charges,75% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,105.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,66.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,35.46,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,35.46,241.16,
NEW PATIENT LEVEL 2 (20 MINS),1499202,CDM,521,RC,99202,HCPCS,Outpatient,,,165,82.5,,44.32,26.86,,,percent of total billed charges,26.86% of total billed charges,123.75,75,,,percent of total billed charges,75% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,123.75,75,,,percent of total billed charges,75% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,132,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,83.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,44.32,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,44.32,241.16,
NEW PATIENT LEVEL 5 (60 MINS),1499205,CDM,521,RC,99205,HCPCS,Outpatient,,,413,206.5,,110.93,26.86,,,percent of total billed charges,26.86% of total billed charges,309.75,75,,,percent of total billed charges,75% of total billed charges ,309.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,309.75,75,,,percent of total billed charges,75% of total billed charges ,309.75,75,,,percent of total billed charges,75% of total billed charges ,330.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,208.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,309.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,110.93,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,110.93,330.4,
PREOP COLON OFFICE VISIT,1499210,CDM,521,RC,99211,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,187.36,101,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,189.22,102,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,241.16,
ESTABLISHED PT LEVEL 1 (5 MINS-NURSE VIS,1499211,CDM,521,RC,99211,HCPCS,Outpatient,,,65,32.5,,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,52,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,32.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,17.46,241.16,
ESTABLISHED PT LEVEL 2 (10 MINS),1499212,CDM,521,RC,99212,HCPCS,Outpatient,,,91.5,45.75,,24.58,26.86,,,percent of total billed charges,26.86% of total billed charges,68.63,75,,,percent of total billed charges,75% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,68.63,75,,,percent of total billed charges,75% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,73.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,46.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,24.58,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,24.58,241.16,
ESTABLISHED PT LEVEL 3 (15 MINS),1499213,CDM,521,RC,99213,HCPCS,Outpatient,,,116.5,58.25,,31.29,26.86,,,percent of total billed charges,26.86% of total billed charges,87.38,75,,,percent of total billed charges,75% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,87.38,75,,,percent of total billed charges,75% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,93.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,58.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,31.29,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,31.29,241.16,
ESTABLISHED PT LEVEL 5 (40 MINS),1499215,CDM,521,RC,99215,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,73.06,241.16,
SUBSEQUENT OBSERVATION CARE 35 MINS,1499226,CDM,521,RC,99226,HCPCS,Outpatient,,,212,106,,56.94,26.86,,,percent of total billed charges,26.86% of total billed charges,159,75,,,percent of total billed charges,75% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,159,75,,,percent of total billed charges,75% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,169.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,106.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,56.94,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,56.94,241.16,
OFFICE CONSULT COMPREHENSIVE-MODERATE,1499244,CDM,521,RC,99244,HCPCS,Outpatient,,,408,204,,109.59,26.86,,,percent of total billed charges,26.86% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges ,306,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,306,75,,,percent of total billed charges,75% of total billed charges ,306,75,,,percent of total billed charges,75% of total billed charges ,326.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,205.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,306,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,109.59,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,109.59,326.4,
OFFICE CONSULT COMPREHENSIVE HIGH,1499245,CDM,521,RC,99245,HCPCS,Outpatient,,,515,257.5,,138.33,26.86,,,percent of total billed charges,26.86% of total billed charges,386.25,75,,,percent of total billed charges,75% of total billed charges ,386.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,386.25,75,,,percent of total billed charges,75% of total billed charges ,386.25,75,,,percent of total billed charges,75% of total billed charges ,412,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,259.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,386.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,138.33,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,138.33,412,
EMERGENCY ROOM VISIT MINIMUM COMPLEXITY,1499283,CDM,521,RC,99283,HCPCS,Outpatient,,,333.5,166.75,,89.58,26.86,,,percent of total billed charges,26.86% of total billed charges,250.13,75,,,percent of total billed charges,75% of total billed charges ,250.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,250.13,75,,,percent of total billed charges,75% of total billed charges ,250.13,75,,,percent of total billed charges,75% of total billed charges ,266.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,168.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,250.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,89.58,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,89.58,266.8,
EMERGENCY ROOM VISIT MEDIUM COMPLEXITY,1499284,CDM,521,RC,99284,HCPCS,Outpatient,,,498.5,249.25,,133.9,26.86,,,percent of total billed charges,26.86% of total billed charges,373.88,75,,,percent of total billed charges,75% of total billed charges ,373.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,373.88,75,,,percent of total billed charges,75% of total billed charges ,373.88,75,,,percent of total billed charges,75% of total billed charges ,398.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,251.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,373.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,133.9,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,133.9,398.8,
EMERGENCY ROOM VISIT HIGH COMPLEXITY,1499285,CDM,450,RC,99285,HCPCS,Outpatient,,,744.5,372.25,,199.97,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,178.68,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,595.6,80,,,percent of total billed charges,80% of total billed charges ,180.47,24.24,,,percent of total billed charges,24.24% of total billed charges ,375.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,558.38,75,,,percent of total billed charges,75% of total billed charges ,182.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,199.97,26.86,,,percent of total billed charges,26.86% of total billed charges,178.68,24,,,percent of total billed charges,24% of total billed charges ,232.28,31.2,,,percent of total billed charges,31.2% of total billed charges,595.6,80,,,percent of total billed charges,80% of total billed charges,178.68,24,,,percent of total billed charges,24% of total billed charges ,178.68,24,,,percent of total billed charges,24% of total billed charges ,178.68,710,
CRITICAL CARE EVAL/MGT EA ADDITIONAL 30,1499292,CDM,521,RC,99292,HCPCS,Outpatient,,,320.5,160.25,,86.09,26.86,,,percent of total billed charges,26.86% of total billed charges,240.38,75,,,percent of total billed charges,75% of total billed charges ,240.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,240.38,75,,,percent of total billed charges,75% of total billed charges ,240.38,75,,,percent of total billed charges,75% of total billed charges ,256.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,161.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,240.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,86.09,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,86.09,256.4,
INITIAL NURSING FACILITY CARE 25 MINS,1499303,CDM,521,RC,99304,HCPCS,Outpatient,,,228.5,114.25,,61.38,26.86,,,percent of total billed charges,26.86% of total billed charges,171.38,75,,,percent of total billed charges,75% of total billed charges ,171.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,171.38,75,,,percent of total billed charges,75% of total billed charges ,171.38,75,,,percent of total billed charges,75% of total billed charges ,182.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,115.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,171.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,61.38,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,61.38,241.16,
INITIAL NURSING FACILITY PER DAY 35 MINS,1499311,CDM,521,RC,99305,HCPCS,Outpatient,,,321.5,160.75,,86.35,26.86,,,percent of total billed charges,26.86% of total billed charges,241.13,75,,,percent of total billed charges,75% of total billed charges ,241.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,241.13,75,,,percent of total billed charges,75% of total billed charges ,241.13,75,,,percent of total billed charges,75% of total billed charges ,257.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,162.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,241.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,86.35,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,86.35,257.2,
INITIAL NURSING FACILITY PER DAY 45 MINU,1499312,CDM,521,RC,99306,HCPCS,Outpatient,,,390.5,195.25,,104.89,26.86,,,percent of total billed charges,26.86% of total billed charges,292.88,75,,,percent of total billed charges,75% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,292.88,75,,,percent of total billed charges,75% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,312.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,196.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,104.89,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,104.89,312.4,
SUBSEQUENT NURSING HOME CARE,1499313,CDM,521,RC,99307,HCPCS,Outpatient,,,129,64.5,,34.65,26.86,,,percent of total billed charges,26.86% of total billed charges,96.75,75,,,percent of total billed charges,75% of total billed charges ,96.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,96.75,75,,,percent of total billed charges,75% of total billed charges ,96.75,75,,,percent of total billed charges,75% of total billed charges ,103.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,65.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,96.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,34.65,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,34.65,241.16,
SUBSEQUENT NURSING CARE 15 MINS,1499314,CDM,521,RC,99308,HCPCS,Outpatient,,,174,87,,46.74,26.86,,,percent of total billed charges,26.86% of total billed charges,130.5,75,,,percent of total billed charges,75% of total billed charges ,130.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,130.5,75,,,percent of total billed charges,75% of total billed charges ,130.5,75,,,percent of total billed charges,75% of total billed charges ,139.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,87.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,130.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,46.74,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,46.74,241.16,
SUBSEQUENT NURSING CARE 25 MINUTES,1499317,CDM,521,RC,99309,HCPCS,Outpatient,,,252.5,126.25,,67.82,26.86,,,percent of total billed charges,26.86% of total billed charges,189.38,75,,,percent of total billed charges,75% of total billed charges ,189.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,189.38,75,,,percent of total billed charges,75% of total billed charges ,189.38,75,,,percent of total billed charges,75% of total billed charges ,202,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,127.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,189.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,67.82,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,67.82,241.16,
NURSING FACILITY DISCHARGE 30 MINS,1499318,CDM,521,RC,99315,HCPCS,Outpatient,,,239,119.5,,64.2,26.86,,,percent of total billed charges,26.86% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges ,179.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,179.25,75,,,percent of total billed charges,75% of total billed charges ,179.25,75,,,percent of total billed charges,75% of total billed charges ,191.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,120.46,50.4,,,percent of total billed charges,50.4% of total billed charges ,179.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,64.2,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,64.2,241.16,
NURSING FACILITY DISCHARGE > 30 MINS,1499319,CDM,521,RC,99316,HCPCS,Outpatient,,,297.5,148.75,,79.91,26.86,,,percent of total billed charges,26.86% of total billed charges,223.13,75,,,percent of total billed charges,75% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,223.13,75,,,percent of total billed charges,75% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,238,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,149.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,79.91,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,79.91,241.16,
HOME VISIT INITIAL VISIT,1499341,CDM,521,RC,99341,HCPCS,Outpatient,,,209,104.5,,56.14,26.86,,,percent of total billed charges,26.86% of total billed charges,156.75,75,,,percent of total billed charges,75% of total billed charges ,156.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,156.75,75,,,percent of total billed charges,75% of total billed charges ,156.75,75,,,percent of total billed charges,75% of total billed charges ,167.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,105.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,156.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,56.14,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,56.14,241.16,
PHYS SUPERVISION OF A PATIENT UNDER CARE,1499374,CDM,521,RC,99374,HCPCS,Outpatient,,,174,87,,46.74,26.86,,,percent of total billed charges,26.86% of total billed charges,130.5,75,,,percent of total billed charges,75% of total billed charges ,130.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,130.5,75,,,percent of total billed charges,75% of total billed charges ,130.5,75,,,percent of total billed charges,75% of total billed charges ,139.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,87.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,130.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,46.74,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,46.74,241.16,
PHYSICIAN SUPER PT UNDER CARE OF HOME HL,1499375,CDM,521,RC,99375,HCPCS,Outpatient,,,321.5,160.75,,86.35,26.86,,,percent of total billed charges,26.86% of total billed charges,241.13,75,,,percent of total billed charges,75% of total billed charges ,241.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,241.13,75,,,percent of total billed charges,75% of total billed charges ,241.13,75,,,percent of total billed charges,75% of total billed charges ,257.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,162.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,241.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,86.35,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,86.35,257.2,
PYSICIAN SUPER OF A HOSPICE PT 15-29 MIN,1499377,CDM,521,RC,99377,HCPCS,Outpatient,,,207,103.5,,55.6,26.86,,,percent of total billed charges,26.86% of total billed charges,155.25,75,,,percent of total billed charges,75% of total billed charges ,155.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,155.25,75,,,percent of total billed charges,75% of total billed charges ,155.25,75,,,percent of total billed charges,75% of total billed charges ,165.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,104.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,155.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,55.6,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,55.6,241.16,
PHYSICIAN SUPER HOSPICE PT 30 MIN OR MOR,1499378,CDM,521,RC,99378,HCPCS,Outpatient,,,366.5,183.25,,98.44,26.86,,,percent of total billed charges,26.86% of total billed charges,274.88,75,,,percent of total billed charges,75% of total billed charges ,274.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,274.88,75,,,percent of total billed charges,75% of total billed charges ,274.88,75,,,percent of total billed charges,75% of total billed charges ,293.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,184.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,274.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,98.44,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,98.44,293.2,
PHYSICIAN SUPER NURSING FACILITY PT 15-2,1499379,CDM,521,RC,99379,HCPCS,Outpatient,,,183.5,91.75,,49.29,26.86,,,percent of total billed charges,26.86% of total billed charges,137.63,75,,,percent of total billed charges,75% of total billed charges ,137.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,137.63,75,,,percent of total billed charges,75% of total billed charges ,137.63,75,,,percent of total billed charges,75% of total billed charges ,146.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,92.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,137.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,49.29,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,49.29,241.16,
PHYSICIAN SUPERVISION OF A NURSING FACIL,1499380,CDM,521,RC,99380,HCPCS,Outpatient,,,288.5,144.25,,77.49,26.86,,,percent of total billed charges,26.86% of total billed charges,216.38,75,,,percent of total billed charges,75% of total billed charges ,216.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,216.38,75,,,percent of total billed charges,75% of total billed charges ,216.38,75,,,percent of total billed charges,75% of total billed charges ,230.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,145.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,216.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,77.49,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,77.49,241.16,
INITIAL COMPREHENSIVE PHYSICAL- UNDER 1,1499381,CDM,521,RC,99381,HCPCS,Outpatient,,,180.5,90.25,,48.48,26.86,,,percent of total billed charges,26.86% of total billed charges,135.38,75,,,percent of total billed charges,75% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,135.38,75,,,percent of total billed charges,75% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,144.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,90.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,48.48,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,48.48,241.16,
INITIAL COMPREH PHYSICAL AGE 1 TO 4 YEAR,1499382,CDM,521,RC,99382,HCPCS,Outpatient,,,193.5,96.75,,51.97,26.86,,,percent of total billed charges,26.86% of total billed charges,145.13,75,,,percent of total billed charges,75% of total billed charges ,145.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,145.13,75,,,percent of total billed charges,75% of total billed charges ,145.13,75,,,percent of total billed charges,75% of total billed charges ,154.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,97.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,145.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,51.97,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,51.97,241.16,
INITIAL COMPREHENSIVE PHYSICAL AGE 5-11,1499383,CDM,521,RC,99383,HCPCS,Outpatient,,,208,104,,55.87,26.86,,,percent of total billed charges,26.86% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges ,156,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,156,75,,,percent of total billed charges,75% of total billed charges ,156,75,,,percent of total billed charges,75% of total billed charges ,166.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,104.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,156,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,55.87,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,55.87,241.16,
INITIAL COMPREHENSIVE PHYSICAL 12-17 YRS,1499384,CDM,521,RC,99384,HCPCS,Outpatient,,,222.5,111.25,,59.76,26.86,,,percent of total billed charges,26.86% of total billed charges,166.88,75,,,percent of total billed charges,75% of total billed charges ,166.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,166.88,75,,,percent of total billed charges,75% of total billed charges ,166.88,75,,,percent of total billed charges,75% of total billed charges ,178,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,112.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,166.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,59.76,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,59.76,241.16,
INITIAL COMPREHENSIVE PREVENTIVE PHYSICA,1499385,CDM,521,RC,99385,HCPCS,Outpatient,,,302,151,,81.12,26.86,,,percent of total billed charges,26.86% of total billed charges,226.5,75,,,percent of total billed charges,75% of total billed charges ,226.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,226.5,75,,,percent of total billed charges,75% of total billed charges ,226.5,75,,,percent of total billed charges,75% of total billed charges ,241.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,152.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,226.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,81.12,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,81.12,241.6,
INITIAL COMPREHENSIVE PHYSICAL 40-64,1499386,CDM,521,RC,99386,HCPCS,Outpatient,,,328.5,164.25,,88.24,26.86,,,percent of total billed charges,26.86% of total billed charges,246.38,75,,,percent of total billed charges,75% of total billed charges ,246.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,246.38,75,,,percent of total billed charges,75% of total billed charges ,246.38,75,,,percent of total billed charges,75% of total billed charges ,262.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,165.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,246.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,88.24,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,88.24,262.8,
INITIAL COMPREHENSIVE PHYSICAL > 65,1499387,CDM,521,RC,99387,HCPCS,Outpatient,,,370,185,,99.38,26.86,,,percent of total billed charges,26.86% of total billed charges,277.5,75,,,percent of total billed charges,75% of total billed charges ,277.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,277.5,75,,,percent of total billed charges,75% of total billed charges ,277.5,75,,,percent of total billed charges,75% of total billed charges ,296,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,186.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,277.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,99.38,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,99.38,296,
PERIODIC COMPREHENSIVE PHYSICAL INFANT (,1499391,CDM,521,RC,99391,HCPCS,Outpatient,,,148.5,74.25,,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,118.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,74.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,39.89,241.16,
PERIODIC COMPREHENSIVE PHYSICAL EARLY CH,1499392,CDM,521,RC,99392,HCPCS,Outpatient,,,156.5,78.25,,42.04,26.86,,,percent of total billed charges,26.86% of total billed charges,117.38,75,,,percent of total billed charges,75% of total billed charges ,117.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,117.38,75,,,percent of total billed charges,75% of total billed charges ,117.38,75,,,percent of total billed charges,75% of total billed charges ,125.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,78.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,117.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,42.04,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,42.04,241.16,
PERIODIC COMPREHENSIVE PHYSICAL-LATE CHI,1499393,CDM,521,RC,99393,HCPCS,Outpatient,,,172,86,,46.2,26.86,,,percent of total billed charges,26.86% of total billed charges,129,75,,,percent of total billed charges,75% of total billed charges ,129,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,129,75,,,percent of total billed charges,75% of total billed charges ,129,75,,,percent of total billed charges,75% of total billed charges ,137.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,86.69,50.4,,,percent of total billed charges,50.4% of total billed charges ,129,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,46.2,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,46.2,241.16,
COMPREHENSIVE PHYSICAL 12-17,1499394,CDM,521,RC,99394,HCPCS,Outpatient,,,185.5,92.75,,49.83,26.86,,,percent of total billed charges,26.86% of total billed charges,139.13,75,,,percent of total billed charges,75% of total billed charges ,139.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,139.13,75,,,percent of total billed charges,75% of total billed charges ,139.13,75,,,percent of total billed charges,75% of total billed charges ,148.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,93.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,139.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,49.83,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,49.83,241.16,
COMPREHENSIVE PHYSICAL 18-39,1499395,CDM,521,RC,99395,HCPCS,Outpatient,,,250.5,125.25,,67.28,26.86,,,percent of total billed charges,26.86% of total billed charges,187.88,75,,,percent of total billed charges,75% of total billed charges ,187.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,187.88,75,,,percent of total billed charges,75% of total billed charges ,187.88,75,,,percent of total billed charges,75% of total billed charges ,200.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,126.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,187.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,67.28,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,67.28,241.16,
COMPREHENSIVE PHYSICAL 40-64 YRS,1499396,CDM,521,RC,99396,HCPCS,Outpatient,,,274,137,,73.6,26.86,,,percent of total billed charges,26.86% of total billed charges,205.5,75,,,percent of total billed charges,75% of total billed charges ,205.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,205.5,75,,,percent of total billed charges,75% of total billed charges ,205.5,75,,,percent of total billed charges,75% of total billed charges ,219.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,138.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,205.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,73.6,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,73.6,241.16,
COMPREHENSIVE PHYSICAL >65,1499397,CDM,521,RC,99397,HCPCS,Outpatient,,,310,155,,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,248,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,156.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,83.27,248,
SPORTS PHYSICAL,1499401,CDM,521,RC,99401,HCPCS,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,7.25,241.16,
LAPAROSCOPY SURG WITH REMOVAL OF ADNEXAL,1499407,CDM,521,RC,58661,HCPCS,Outpatient,,,1710,855,,459.31,26.86,,,percent of total billed charges,26.86% of total billed charges,1282.5,75,,,percent of total billed charges,75% of total billed charges ,1282.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1282.5,75,,,percent of total billed charges,75% of total billed charges ,1282.5,75,,,percent of total billed charges,75% of total billed charges ,1368,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,861.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,1282.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,459.31,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1368,
"THYROIDECTOMY, REMOVAL OF ALL REMAINING",1499408,CDM,521,RC,60260,HCPCS,Outpatient,,,2860.5,1430.25,,768.33,26.86,,,percent of total billed charges,26.86% of total billed charges,2145.38,75,,,percent of total billed charges,75% of total billed charges ,2145.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,2145.38,75,,,percent of total billed charges,75% of total billed charges ,2145.38,75,,,percent of total billed charges,75% of total billed charges ,2288.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1441.69,50.4,,,percent of total billed charges,50.4% of total billed charges ,2145.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,768.33,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,2288.4,
ENTEROLYSIS FREEING OF INTESTINAL ADHESI,1499409,CDM,521,RC,44005,HCPCS,Outpatient,,,2844,1422,,763.9,26.86,,,percent of total billed charges,26.86% of total billed charges,2133,75,,,percent of total billed charges,75% of total billed charges ,2133,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,2133,75,,,percent of total billed charges,75% of total billed charges ,2133,75,,,percent of total billed charges,75% of total billed charges ,2275.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1433.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,2133,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,763.9,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,2275.2,
SALPINGO-OOHORECTOMY COMPLETE OR PARTIAL,1499410,CDM,521,RC,58720,HCPCS,Outpatient,,,1917,958.5,,514.91,26.86,,,percent of total billed charges,26.86% of total billed charges,1437.75,75,,,percent of total billed charges,75% of total billed charges ,1437.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1437.75,75,,,percent of total billed charges,75% of total billed charges ,1437.75,75,,,percent of total billed charges,75% of total billed charges ,1533.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,966.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,1437.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,514.91,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1533.6,
LYSIS OF ADHESIONS SALPINGOLYSIS OVARIOL,1499411,CDM,521,RC,58740,HCPCS,Outpatient,,,2313.5,1156.75,,621.41,26.86,,,percent of total billed charges,26.86% of total billed charges,1735.13,75,,,percent of total billed charges,75% of total billed charges ,1735.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1735.13,75,,,percent of total billed charges,75% of total billed charges ,1735.13,75,,,percent of total billed charges,75% of total billed charges ,1850.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1166,50.4,,,percent of total billed charges,50.4% of total billed charges ,1735.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,621.41,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1850.8,
EXCISION OF LESION OF TENDON SHEATH OR C,1499412,CDM,521,RC,27630,HCPCS,Outpatient,,,946.5,473.25,,254.23,26.86,,,percent of total billed charges,26.86% of total billed charges,709.88,75,,,percent of total billed charges,75% of total billed charges ,709.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,709.88,75,,,percent of total billed charges,75% of total billed charges ,709.88,75,,,percent of total billed charges,75% of total billed charges ,757.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,477.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,709.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,254.23,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,757.2,
REPAIR INITAL INCISIONAL OR VENTRAL HERN,1499413,CDM,521,RC,49561,HCPCS,Outpatient,,,2411,1205.5,,647.59,26.86,,,percent of total billed charges,26.86% of total billed charges,1808.25,75,,,percent of total billed charges,75% of total billed charges ,1808.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1808.25,75,,,percent of total billed charges,75% of total billed charges ,1808.25,75,,,percent of total billed charges,75% of total billed charges ,1928.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1215.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,1808.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,647.59,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1928.8,
EXCISION TUMOR SOFT TISSUE OF PELVIS AND,1499414,CDM,521,RC,27048,HCPCS,Outpatient,,,1569.5,784.75,,421.57,26.86,,,percent of total billed charges,26.86% of total billed charges,1177.13,75,,,percent of total billed charges,75% of total billed charges ,1177.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1177.13,75,,,percent of total billed charges,75% of total billed charges ,1177.13,75,,,percent of total billed charges,75% of total billed charges ,1255.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,791.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,1177.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,421.57,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1255.6,
BIOPSY SOFT TISSUE OF NECK OR THORAX,1499415,CDM,521,RC,21550,HCPCS,Outpatient,,,405,202.5,,108.78,26.86,,,percent of total billed charges,26.86% of total billed charges,303.75,75,,,percent of total billed charges,75% of total billed charges ,303.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,303.75,75,,,percent of total billed charges,75% of total billed charges ,303.75,75,,,percent of total billed charges,75% of total billed charges ,324,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,204.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,303.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,108.78,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,108.78,324,
EXCISION BENIGN LESION INCLUDING MARGINS,1499416,CDM,521,RC,11421,HCPCS,Outpatient,,,282,141,,75.75,26.86,,,percent of total billed charges,26.86% of total billed charges,211.5,75,,,percent of total billed charges,75% of total billed charges ,211.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,211.5,75,,,percent of total billed charges,75% of total billed charges ,211.5,75,,,percent of total billed charges,75% of total billed charges ,225.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,142.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,211.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,75.75,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,75.75,241.16,
EXCISION OR DESTRUCTION OPEN INTRA ABDOM,1499417,CDM,521,RC,49203,HCPCS,Outpatient,,,3114.5,1557.25,,836.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2335.88,75,,,percent of total billed charges,75% of total billed charges ,2335.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,2335.88,75,,,percent of total billed charges,75% of total billed charges ,2335.88,75,,,percent of total billed charges,75% of total billed charges ,2491.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1569.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,2335.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,836.55,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,2491.6,
REOPENING OF RECENT LAPAROTOMY,1499418,CDM,521,RC,49002,HCPCS,Outpatient,,,2723.5,1361.75,,731.53,26.86,,,percent of total billed charges,26.86% of total billed charges,2042.63,75,,,percent of total billed charges,75% of total billed charges ,2042.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,2042.63,75,,,percent of total billed charges,75% of total billed charges ,2042.63,75,,,percent of total billed charges,75% of total billed charges ,2178.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1372.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,2042.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,731.53,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,2178.8,
DRAINAGE OF PERITIONEAL ABSCESS OR LOCAL,1499419,CDM,521,RC,49020,HCPCS,Outpatient,,,4134.5,2067.25,,1110.53,26.86,,,percent of total billed charges,26.86% of total billed charges,3100.88,75,,,percent of total billed charges,75% of total billed charges ,3100.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,3100.88,75,,,percent of total billed charges,75% of total billed charges ,3100.88,75,,,percent of total billed charges,75% of total billed charges ,3307.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,2083.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,3100.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,1110.53,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,3307.6,
ARTERIAL BLOOD GAS,1712013,CDM,301,RC,82803,HCPCS,Outpatient,,,483,241.5,,24.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,115.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,386.4,80,,,percent of total billed charges,80% of total billed charges ,117.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,243.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,362.25,75,,,percent of total billed charges,75% of total billed charges ,118.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,115.92,24,,,percent of total billed charges,24% of total billed charges ,150.7,31.2,,,percent of total billed charges,31.2% of total billed charges,386.4,80,,,percent of total billed charges,80% of total billed charges,115.92,24,,,percent of total billed charges,24% of total billed charges ,115.92,24,,,percent of total billed charges,24% of total billed charges ,24.34,386.4,
BICARBONATE [MOLES/VOLUME] IN ARTERIAL B,1713005,CDM,301,RC,82374,HCPCS,Outpatient,,,83.5,41.75,,6.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,6.15,66.8,
PH OF BLOOD,1716033,CDM,301,RC,83986,HCPCS,Outpatient,,,72,36,,4.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,4.5,57.6,
GAS PANEL IN ARTERIAL BLOOD,1719248,CDM,460,RC,82803,HCPCS,Outpatient,,,474,237,,24.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,113.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,379.2,80,,,percent of total billed charges,80% of total billed charges ,114.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,238.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,116.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,113.76,24,,,percent of total billed charges,24% of total billed charges ,147.89,31.2,,,percent of total billed charges,31.2% of total billed charges,379.2,80,,,percent of total billed charges,80% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,24.34,379.2,
EKG,1730002,CDM,730,RC,93005,HCPCS,Outpatient,,,279,139.5,,74.94,26.86,,,percent of total billed charges,26.86% of total billed charges,209.25,75,,,percent of total billed charges,75% of total billed charges ,209.25,75,,,percent of total billed charges,75% of total billed charges ,66.96,24,,,percent of total billed charges,24% of total billed charges ,209.25,75,,,percent of total billed charges,75% of total billed charges ,209.25,75,,,percent of total billed charges,75% of total billed charges ,223.2,80,,,percent of total billed charges,80% of total billed charges ,67.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,140.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,209.25,75,,,percent of total billed charges,75% of total billed charges ,68.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,74.94,26.86,,,percent of total billed charges,26.86% of total billed charges,66.96,24,,,percent of total billed charges,24% of total billed charges ,87.05,31.2,,,percent of total billed charges,31.2% of total billed charges,223.2,80,,,percent of total billed charges,80% of total billed charges,66.96,24,,,percent of total billed charges,24% of total billed charges ,66.96,24,,,percent of total billed charges,24% of total billed charges ,66.96,223.2,
PEP/VIBRTION SUBSEQU,1730003,CDM,410,RC,94668,HCPCS,Outpatient,,,104,52,,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,83.2,80,,,percent of total billed charges,80% of total billed charges ,25.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,25.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,32.45,31.2,,,percent of total billed charges,31.2% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,83.2,
CARDIAC NUCLEAR STRESS TESTING,1730005,CDM,482,RC,93015,HCPCS,Outpatient,,,2372,1186,,637.12,26.86,,,percent of total billed charges,26.86% of total billed charges,1779,75,,,percent of total billed charges,75% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,569.28,24,,,percent of total billed charges,24% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,1897.6,80,,,percent of total billed charges,80% of total billed charges ,574.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,1195.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,580.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,637.12,26.86,,,percent of total billed charges,26.86% of total billed charges,569.28,24,,,percent of total billed charges,24% of total billed charges ,740.06,31.2,,,percent of total billed charges,31.2% of total billed charges,1897.6,80,,,percent of total billed charges,80% of total billed charges,569.28,24,,,percent of total billed charges,24% of total billed charges ,569.28,24,,,percent of total billed charges,24% of total billed charges ,569.28,1897.6,
HOLTER MONITER HK-UP,1730007,CDM,270,RC,,,Outpatient,,,530.5,265.25,,142.49,26.86,,,percent of total billed charges,26.86% of total billed charges,397.88,75,,,percent of total billed charges,75% of total billed charges ,397.88,75,,,percent of total billed charges,75% of total billed charges ,127.32,24,,,percent of total billed charges,24% of total billed charges ,397.88,75,,,percent of total billed charges,75% of total billed charges ,397.88,75,,,percent of total billed charges,75% of total billed charges ,424.4,80,,,percent of total billed charges,80% of total billed charges ,128.59,24.24,,,percent of total billed charges,24.24% of total billed charges ,267.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,397.88,75,,,percent of total billed charges,75% of total billed charges ,129.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,142.49,26.86,,,percent of total billed charges,26.86% of total billed charges,127.32,24,,,percent of total billed charges,24% of total billed charges ,165.52,31.2,,,percent of total billed charges,31.2% of total billed charges,424.4,80,,,percent of total billed charges,80% of total billed charges,127.32,24,,,percent of total billed charges,24% of total billed charges ,127.32,24,,,percent of total billed charges,24% of total billed charges ,127.32,424.4,
HOLTER MONITOR UP TO 48 HRS,1730010,CDM,731,RC,93225,HCPCS,Outpatient,,,710.5,355.25,,190.84,26.86,,,percent of total billed charges,26.86% of total billed charges,532.88,75,,,percent of total billed charges,75% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,170.52,24,,,percent of total billed charges,24% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,568.4,80,,,percent of total billed charges,80% of total billed charges ,172.23,24.24,,,percent of total billed charges,24.24% of total billed charges ,358.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,173.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,190.84,26.86,,,percent of total billed charges,26.86% of total billed charges,170.52,24,,,percent of total billed charges,24% of total billed charges ,221.68,31.2,,,percent of total billed charges,31.2% of total billed charges,568.4,80,,,percent of total billed charges,80% of total billed charges,170.52,24,,,percent of total billed charges,24% of total billed charges ,170.52,24,,,percent of total billed charges,24% of total billed charges ,170.52,568.4,
HHN INITIAL TX W/EQUIP,1730011,CDM,410,RC,94664,HCPCS,Outpatient,,,309,154.5,,83,26.86,,,percent of total billed charges,26.86% of total billed charges,231.75,75,,,percent of total billed charges,75% of total billed charges ,231.75,75,,,percent of total billed charges,75% of total billed charges ,74.16,24,,,percent of total billed charges,24% of total billed charges ,231.75,75,,,percent of total billed charges,75% of total billed charges ,231.75,75,,,percent of total billed charges,75% of total billed charges ,247.2,80,,,percent of total billed charges,80% of total billed charges ,74.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,155.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,231.75,75,,,percent of total billed charges,75% of total billed charges ,75.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,83,26.86,,,percent of total billed charges,26.86% of total billed charges,74.16,24,,,percent of total billed charges,24% of total billed charges ,96.41,31.2,,,percent of total billed charges,31.2% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,74.16,24,,,percent of total billed charges,24% of total billed charges ,74.16,24,,,percent of total billed charges,24% of total billed charges ,74.16,247.2,
6 MINUTE WALK TEST,1730012,CDM,460,RC,94618,HCPCS,Outpatient,,,265.5,132.75,,71.31,26.86,,,percent of total billed charges,26.86% of total billed charges,199.13,75,,,percent of total billed charges,75% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,63.72,24,,,percent of total billed charges,24% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,212.4,80,,,percent of total billed charges,80% of total billed charges ,64.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,133.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,64.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,71.31,26.86,,,percent of total billed charges,26.86% of total billed charges,63.72,24,,,percent of total billed charges,24% of total billed charges ,82.84,31.2,,,percent of total billed charges,31.2% of total billed charges,212.4,80,,,percent of total billed charges,80% of total billed charges,63.72,24,,,percent of total billed charges,24% of total billed charges ,63.72,24,,,percent of total billed charges,24% of total billed charges ,63.72,212.4,
MDI INITIAL TX W/DEMO,1730014,CDM,410,RC,94664,HCPCS,Outpatient,,,178,89,,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,142.4,
OXYHOOD SETUP,1730015,CDM,410,RC,94640,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
OXYHOOD DAILY CHARGE,1730016,CDM,410,RC,94640,HCPCS,Outpatient,,,166,83,,44.59,26.86,,,percent of total billed charges,26.86% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,44.59,26.86,,,percent of total billed charges,26.86% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,132.8,
O2 SETUP COMPLETE,1730020,CDM,410,RC,94640,HCPCS,Outpatient,,,126.5,63.25,,33.98,26.86,,,percent of total billed charges,26.86% of total billed charges,94.88,75,,,percent of total billed charges,75% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,30.36,24,,,percent of total billed charges,24% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,101.2,80,,,percent of total billed charges,80% of total billed charges ,30.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,63.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,30.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,33.98,26.86,,,percent of total billed charges,26.86% of total billed charges,30.36,24,,,percent of total billed charges,24% of total billed charges ,39.47,31.2,,,percent of total billed charges,31.2% of total billed charges,101.2,80,,,percent of total billed charges,80% of total billed charges,30.36,24,,,percent of total billed charges,24% of total billed charges ,30.36,24,,,percent of total billed charges,24% of total billed charges ,30.36,101.2,
PULSE OX/02 EVALUATION,1730025,CDM,460,RC,94760,HCPCS,Outpatient,,,59.5,29.75,,15.98,26.86,,,percent of total billed charges,26.86% of total billed charges,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.98,26.86,,,percent of total billed charges,26.86% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,47.6,
PEAK FLOW,1730044,CDM,460,RC,94150,HCPCS,Outpatient,,,119.5,59.75,,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,95.6,
COMPLETE PFT W/POST BRONCHODILATOR SPIRO,1730047,CDM,460,RC,94060,HCPCS,Outpatient,,,668.5,334.25,,179.56,26.86,,,percent of total billed charges,26.86% of total billed charges,501.38,75,,,percent of total billed charges,75% of total billed charges ,501.38,75,,,percent of total billed charges,75% of total billed charges ,160.44,24,,,percent of total billed charges,24% of total billed charges ,501.38,75,,,percent of total billed charges,75% of total billed charges ,501.38,75,,,percent of total billed charges,75% of total billed charges ,534.8,80,,,percent of total billed charges,80% of total billed charges ,162.04,24.24,,,percent of total billed charges,24.24% of total billed charges ,336.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,501.38,75,,,percent of total billed charges,75% of total billed charges ,163.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,179.56,26.86,,,percent of total billed charges,26.86% of total billed charges,160.44,24,,,percent of total billed charges,24% of total billed charges ,208.57,31.2,,,percent of total billed charges,31.2% of total billed charges,534.8,80,,,percent of total billed charges,80% of total billed charges,160.44,24,,,percent of total billed charges,24% of total billed charges ,160.44,24,,,percent of total billed charges,24% of total billed charges ,160.44,534.8,
VENTILATOR EACH ADDITIONAL DAY,1730055,CDM,410,RC,94003,HCPCS,Outpatient,,,1280.5,640.25,,343.94,26.86,,,percent of total billed charges,26.86% of total billed charges,960.38,75,,,percent of total billed charges,75% of total billed charges ,960.38,75,,,percent of total billed charges,75% of total billed charges ,307.32,24,,,percent of total billed charges,24% of total billed charges ,960.38,75,,,percent of total billed charges,75% of total billed charges ,960.38,75,,,percent of total billed charges,75% of total billed charges ,1024.4,80,,,percent of total billed charges,80% of total billed charges ,310.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,645.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,960.38,75,,,percent of total billed charges,75% of total billed charges ,313.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,343.94,26.86,,,percent of total billed charges,26.86% of total billed charges,307.32,24,,,percent of total billed charges,24% of total billed charges ,399.52,31.2,,,percent of total billed charges,31.2% of total billed charges,1024.4,80,,,percent of total billed charges,80% of total billed charges,307.32,24,,,percent of total billed charges,24% of total billed charges ,307.32,24,,,percent of total billed charges,24% of total billed charges ,307.32,1024.4,
INITIATE MECHANICAL VENTILATION,1730056,CDM,410,RC,94002,HCPCS,Outpatient,,,1280.5,640.25,,343.94,26.86,,,percent of total billed charges,26.86% of total billed charges,960.38,75,,,percent of total billed charges,75% of total billed charges ,960.38,75,,,percent of total billed charges,75% of total billed charges ,307.32,24,,,percent of total billed charges,24% of total billed charges ,960.38,75,,,percent of total billed charges,75% of total billed charges ,960.38,75,,,percent of total billed charges,75% of total billed charges ,1024.4,80,,,percent of total billed charges,80% of total billed charges ,310.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,645.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,960.38,75,,,percent of total billed charges,75% of total billed charges ,313.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,343.94,26.86,,,percent of total billed charges,26.86% of total billed charges,307.32,24,,,percent of total billed charges,24% of total billed charges ,399.52,31.2,,,percent of total billed charges,31.2% of total billed charges,1024.4,80,,,percent of total billed charges,80% of total billed charges,307.32,24,,,percent of total billed charges,24% of total billed charges ,307.32,24,,,percent of total billed charges,24% of total billed charges ,307.32,1024.4,
AEROSOL DAILY CHARGE,1730068,CDM,460,RC,94665,HCPCS,Outpatient,,,166,83,,44.59,26.86,,,percent of total billed charges,26.86% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,44.59,26.86,,,percent of total billed charges,26.86% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,132.8,
INCENT SPIROM-INIT,1730076,CDM,460,RC,94200,HCPCS,Outpatient,,,178,89,,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,142.4,
INCENT SPIROM-SUBSEQ,1730077,CDM,460,RC,94200,HCPCS,Outpatient,,,119.5,59.75,,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,95.6,
EZ-PAP INITIAL,1731017,CDM,410,RC,94640,HCPCS,Outpatient,,,79.5,39.75,,21.35,26.86,,,percent of total billed charges,26.86% of total billed charges,59.63,75,,,percent of total billed charges,75% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,19.08,24,,,percent of total billed charges,24% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,63.6,80,,,percent of total billed charges,80% of total billed charges ,19.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,40.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,19.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.35,26.86,,,percent of total billed charges,26.86% of total billed charges,19.08,24,,,percent of total billed charges,24% of total billed charges ,24.8,31.2,,,percent of total billed charges,31.2% of total billed charges,63.6,80,,,percent of total billed charges,80% of total billed charges,19.08,24,,,percent of total billed charges,24% of total billed charges ,19.08,24,,,percent of total billed charges,24% of total billed charges ,19.08,63.6,
AEROSOL SETUP,1731034,CDM,410,RC,94664,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
HHN OBS W/O EQUIP,1731057,CDM,410,RC,94640,HCPCS,Outpatient,,,534.5,267.25,,143.57,26.86,,,percent of total billed charges,26.86% of total billed charges,400.88,75,,,percent of total billed charges,75% of total billed charges ,400.88,75,,,percent of total billed charges,75% of total billed charges ,128.28,24,,,percent of total billed charges,24% of total billed charges ,400.88,75,,,percent of total billed charges,75% of total billed charges ,400.88,75,,,percent of total billed charges,75% of total billed charges ,427.6,80,,,percent of total billed charges,80% of total billed charges ,129.56,24.24,,,percent of total billed charges,24.24% of total billed charges ,269.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,400.88,75,,,percent of total billed charges,75% of total billed charges ,130.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,143.57,26.86,,,percent of total billed charges,26.86% of total billed charges,128.28,24,,,percent of total billed charges,24% of total billed charges ,166.76,31.2,,,percent of total billed charges,31.2% of total billed charges,427.6,80,,,percent of total billed charges,80% of total billed charges,128.28,24,,,percent of total billed charges,24% of total billed charges ,128.28,24,,,percent of total billed charges,24% of total billed charges ,128.28,427.6,
HHN OBS W/ EQUIP,1731058,CDM,410,RC,94640,HCPCS,Outpatient,,,665.5,332.75,,178.75,26.86,,,percent of total billed charges,26.86% of total billed charges,499.13,75,,,percent of total billed charges,75% of total billed charges ,499.13,75,,,percent of total billed charges,75% of total billed charges ,159.72,24,,,percent of total billed charges,24% of total billed charges ,499.13,75,,,percent of total billed charges,75% of total billed charges ,499.13,75,,,percent of total billed charges,75% of total billed charges ,532.4,80,,,percent of total billed charges,80% of total billed charges ,161.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,335.41,50.4,,,percent of total billed charges,50.4% of total billed charges ,499.13,75,,,percent of total billed charges,75% of total billed charges ,162.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,178.75,26.86,,,percent of total billed charges,26.86% of total billed charges,159.72,24,,,percent of total billed charges,24% of total billed charges ,207.64,31.2,,,percent of total billed charges,31.2% of total billed charges,532.4,80,,,percent of total billed charges,80% of total billed charges,159.72,24,,,percent of total billed charges,24% of total billed charges ,159.72,24,,,percent of total billed charges,24% of total billed charges ,159.72,532.4,
HHN ER W/O EQUIP,1731059,CDM,410,RC,94640,HCPCS,Outpatient,,,356.5,178.25,,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,285.2,
HHN ER W/ EQUIP,1731060,CDM,410,RC,94640,HCPCS,Outpatient,,,487,243.5,,130.81,26.86,,,percent of total billed charges,26.86% of total billed charges,365.25,75,,,percent of total billed charges,75% of total billed charges ,365.25,75,,,percent of total billed charges,75% of total billed charges ,116.88,24,,,percent of total billed charges,24% of total billed charges ,365.25,75,,,percent of total billed charges,75% of total billed charges ,365.25,75,,,percent of total billed charges,75% of total billed charges ,389.6,80,,,percent of total billed charges,80% of total billed charges ,118.05,24.24,,,percent of total billed charges,24.24% of total billed charges ,245.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,365.25,75,,,percent of total billed charges,75% of total billed charges ,119.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,130.81,26.86,,,percent of total billed charges,26.86% of total billed charges,116.88,24,,,percent of total billed charges,24% of total billed charges ,151.94,31.2,,,percent of total billed charges,31.2% of total billed charges,389.6,80,,,percent of total billed charges,80% of total billed charges,116.88,24,,,percent of total billed charges,24% of total billed charges ,116.88,24,,,percent of total billed charges,24% of total billed charges ,116.88,389.6,
HHN INITIAL TX W/O EQUIP,1731061,CDM,410,RC,94640,HCPCS,Outpatient,,,178,89,,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,142.4,
HHN DAILY SUBSEQUENT,1731062,CDM,410,RC,94640,HCPCS,Outpatient,,,178,89,,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,142.4,
HHN SUBSEQUENT 3rd,1731063,CDM,410,RC,94640,HCPCS,Outpatient,,,178,89,,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,142.4,
HHN SUBSEQUENT 4th,1731064,CDM,410,RC,94640,HCPCS,Outpatient,,,178,89,,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,142.4,
SPIROMETRY,1731066,CDM,460,RC,94010,HCPCS,Outpatient,,,178,89,,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,142.4,
CHEST P/T&P/D INITAL,1731067,CDM,410,RC,94667,HCPCS,Outpatient,,,119.5,59.75,,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,95.6,
SUCTION,1731068,CDM,410,RC,31720,HCPCS,Outpatient,,,83.5,41.75,,22.43,26.86,,,percent of total billed charges,26.86% of total billed charges,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.43,26.86,,,percent of total billed charges,26.86% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,66.8,
SPUTUM INDUCTION,1731069,CDM,410,RC,89220,HCPCS,Outpatient,,,83.5,41.75,,22.43,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.43,26.86,,,percent of total billed charges,26.86% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,66.8,
CHEST P/T&PD-SUBSEQ,1731070,CDM,410,RC,94668,HCPCS,Outpatient,,,96,48,,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,76.8,
CPAP/BIPAP SETUP,1731071,CDM,410,RC,94660,HCPCS,Outpatient,,,356.5,178.25,,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,285.2,
CPAP/BIPAP DAILY,1731072,CDM,410,RC,94660,HCPCS,Outpatient,,,356.5,178.25,,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,285.2,
AERO CHAMBER,1731073,CDM,270,RC,,,Outpatient,,,133,66.5,,35.72,26.86,,,percent of total billed charges,26.86% of total billed charges,99.75,75,,,percent of total billed charges,75% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,31.92,24,,,percent of total billed charges,24% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,106.4,80,,,percent of total billed charges,80% of total billed charges ,32.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,67.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,32.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.72,26.86,,,percent of total billed charges,26.86% of total billed charges,31.92,24,,,percent of total billed charges,24% of total billed charges ,41.5,31.2,,,percent of total billed charges,31.2% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,31.92,24,,,percent of total billed charges,24% of total billed charges ,31.92,24,,,percent of total billed charges,24% of total billed charges ,31.92,106.4,
MDI INTITIAL DAILY TX,1731077,CDM,410,RC,94640,HCPCS,Outpatient,,,119.5,59.75,,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,95.6,
MDI DAILY SUBSEQUENT,1731078,CDM,410,RC,94640,HCPCS,Outpatient,,,119.5,59.75,,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,95.6,
MDI SUBSEQUENT TX 2nd,1731079,CDM,410,RC,94640,HCPCS,Outpatient,,,119.5,59.75,,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,95.6,
MDI SUBSEQUENT TX 3rd,1731080,CDM,410,RC,94640,HCPCS,Outpatient,,,119.5,59.75,,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,95.6,
TRACH CARE,1731081,CDM,410,RC,31720,HCPCS,Outpatient,,,119.5,59.75,,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,95.6,
PEAK FLOW-SUBSEQUENT,1731082,CDM,460,RC,94010,HCPCS,Outpatient,,,72,36,,19.34,26.86,,,percent of total billed charges,26.86% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.34,26.86,,,percent of total billed charges,26.86% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,57.6,
INTUBATION,1731084,CDM,361,RC,31500,HCPCS,Outpatient,,,796,398,,213.81,26.86,,,percent of total billed charges,26.86% of total billed charges,597,75,,,percent of total billed charges,75% of total billed charges ,597,75,,,percent of total billed charges,75% of total billed charges ,191.04,24,,,percent of total billed charges,24% of total billed charges ,597,75,,,percent of total billed charges,75% of total billed charges ,597,75,,,percent of total billed charges,75% of total billed charges ,636.8,80,,,percent of total billed charges,80% of total billed charges ,192.95,24.24,,,percent of total billed charges,24.24% of total billed charges ,401.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,597,75,,,percent of total billed charges,75% of total billed charges ,194.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,213.81,26.86,,,percent of total billed charges,26.86% of total billed charges,191.04,24,,,percent of total billed charges,24% of total billed charges ,248.35,31.2,,,percent of total billed charges,31.2% of total billed charges,636.8,80,,,percent of total billed charges,80% of total billed charges,191.04,24,,,percent of total billed charges,24% of total billed charges ,191.04,24,,,percent of total billed charges,24% of total billed charges ,191.04,636.8,
EXTUBATION,1731085,CDM,460,RC,94799,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
RESP THERAPY CONSULT,1731086,CDM,410,RC,94664,HCPCS,Outpatient,,,390.5,195.25,,104.89,26.86,,,percent of total billed charges,26.86% of total billed charges,292.88,75,,,percent of total billed charges,75% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,93.72,24,,,percent of total billed charges,24% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,312.4,80,,,percent of total billed charges,80% of total billed charges ,94.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,196.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,95.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,104.89,26.86,,,percent of total billed charges,26.86% of total billed charges,93.72,24,,,percent of total billed charges,24% of total billed charges ,121.84,31.2,,,percent of total billed charges,31.2% of total billed charges,312.4,80,,,percent of total billed charges,80% of total billed charges,93.72,24,,,percent of total billed charges,24% of total billed charges ,93.72,24,,,percent of total billed charges,24% of total billed charges ,93.72,312.4,
FUNCT RESIDUAL CAPAC,1731089,CDM,460,RC,94727,HCPCS,Outpatient,,,355.5,177.75,,95.49,26.86,,,percent of total billed charges,26.86% of total billed charges,266.63,75,,,percent of total billed charges,75% of total billed charges ,266.63,75,,,percent of total billed charges,75% of total billed charges ,85.32,24,,,percent of total billed charges,24% of total billed charges ,266.63,75,,,percent of total billed charges,75% of total billed charges ,266.63,75,,,percent of total billed charges,75% of total billed charges ,284.4,80,,,percent of total billed charges,80% of total billed charges ,86.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,266.63,75,,,percent of total billed charges,75% of total billed charges ,87.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.49,26.86,,,percent of total billed charges,26.86% of total billed charges,85.32,24,,,percent of total billed charges,24% of total billed charges ,110.92,31.2,,,percent of total billed charges,31.2% of total billed charges,284.4,80,,,percent of total billed charges,80% of total billed charges,85.32,24,,,percent of total billed charges,24% of total billed charges ,85.32,24,,,percent of total billed charges,24% of total billed charges ,85.32,284.4,
DIFFUSION CAPACITY,1731090,CDM,460,RC,94729,HCPCS,Outpatient,,,355.5,177.75,,95.49,26.86,,,percent of total billed charges,26.86% of total billed charges,266.63,75,,,percent of total billed charges,75% of total billed charges ,266.63,75,,,percent of total billed charges,75% of total billed charges ,85.32,24,,,percent of total billed charges,24% of total billed charges ,266.63,75,,,percent of total billed charges,75% of total billed charges ,266.63,75,,,percent of total billed charges,75% of total billed charges ,284.4,80,,,percent of total billed charges,80% of total billed charges ,86.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,266.63,75,,,percent of total billed charges,75% of total billed charges ,87.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.49,26.86,,,percent of total billed charges,26.86% of total billed charges,85.32,24,,,percent of total billed charges,24% of total billed charges ,110.92,31.2,,,percent of total billed charges,31.2% of total billed charges,284.4,80,,,percent of total billed charges,80% of total billed charges,85.32,24,,,percent of total billed charges,24% of total billed charges ,85.32,24,,,percent of total billed charges,24% of total billed charges ,85.32,284.4,
MAX VOLUNTARY VENTIL,1731091,CDM,460,RC,94200,HCPCS,Outpatient,,,159.5,79.75,,42.84,26.86,,,percent of total billed charges,26.86% of total billed charges,119.63,75,,,percent of total billed charges,75% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,38.28,24,,,percent of total billed charges,24% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,127.6,80,,,percent of total billed charges,80% of total billed charges ,38.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,80.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,39.05,24.48,,,percent of total billed charges,24.48% of total billed charges ,42.84,26.86,,,percent of total billed charges,26.86% of total billed charges,38.28,24,,,percent of total billed charges,24% of total billed charges ,49.76,31.2,,,percent of total billed charges,31.2% of total billed charges,127.6,80,,,percent of total billed charges,80% of total billed charges,38.28,24,,,percent of total billed charges,24% of total billed charges ,38.28,24,,,percent of total billed charges,24% of total billed charges ,38.28,127.6,
PFT-PRE ONLY,1731092,CDM,460,RC,94010,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
DAILY O2/CHANGE O2,1731093,CDM,272,RC,,,Outpatient,,,254.5,127.25,,68.36,26.86,,,percent of total billed charges,26.86% of total billed charges,190.88,75,,,percent of total billed charges,75% of total billed charges ,190.88,75,,,percent of total billed charges,75% of total billed charges ,61.08,24,,,percent of total billed charges,24% of total billed charges ,190.88,75,,,percent of total billed charges,75% of total billed charges ,190.88,75,,,percent of total billed charges,75% of total billed charges ,203.6,80,,,percent of total billed charges,80% of total billed charges ,61.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,128.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,190.88,75,,,percent of total billed charges,75% of total billed charges ,62.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,68.36,26.86,,,percent of total billed charges,26.86% of total billed charges,61.08,24,,,percent of total billed charges,24% of total billed charges ,79.4,31.2,,,percent of total billed charges,31.2% of total billed charges,203.6,80,,,percent of total billed charges,80% of total billed charges,61.08,24,,,percent of total billed charges,24% of total billed charges ,61.08,24,,,percent of total billed charges,24% of total billed charges ,61.08,203.6,
CONTINIOUS PULSE OXIMETRY MONITORING,1731094,CDM,460,RC,94762,HCPCS,Outpatient,,,71,35.5,,19.07,26.86,,,percent of total billed charges,26.86% of total billed charges,53.25,75,,,percent of total billed charges,75% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,56.8,80,,,percent of total billed charges,80% of total billed charges ,17.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.07,26.86,,,percent of total billed charges,26.86% of total billed charges,17.04,24,,,percent of total billed charges,24% of total billed charges ,22.15,31.2,,,percent of total billed charges,31.2% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,17.04,24,,,percent of total billed charges,24% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,17.04,56.8,
PULMONARY TREADMILL STRESS,1732000,CDM,460,RC,94621,HCPCS,Outpatient,,,880.5,440.25,,236.5,26.86,,,percent of total billed charges,26.86% of total billed charges,660.38,75,,,percent of total billed charges,75% of total billed charges ,660.38,75,,,percent of total billed charges,75% of total billed charges ,211.32,24,,,percent of total billed charges,24% of total billed charges ,660.38,75,,,percent of total billed charges,75% of total billed charges ,660.38,75,,,percent of total billed charges,75% of total billed charges ,704.4,80,,,percent of total billed charges,80% of total billed charges ,213.43,24.24,,,percent of total billed charges,24.24% of total billed charges ,443.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,660.38,75,,,percent of total billed charges,75% of total billed charges ,215.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,236.5,26.86,,,percent of total billed charges,26.86% of total billed charges,211.32,24,,,percent of total billed charges,24% of total billed charges ,274.72,31.2,,,percent of total billed charges,31.2% of total billed charges,704.4,80,,,percent of total billed charges,80% of total billed charges,211.32,24,,,percent of total billed charges,24% of total billed charges ,211.32,24,,,percent of total billed charges,24% of total billed charges ,211.32,704.4,
EZ-PAP SUBSEQUENT,1741017,CDM,460,RC,94645,HCPCS,Outpatient,,,79.5,39.75,,21.35,26.86,,,percent of total billed charges,26.86% of total billed charges,59.63,75,,,percent of total billed charges,75% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,19.08,24,,,percent of total billed charges,24% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,63.6,80,,,percent of total billed charges,80% of total billed charges ,19.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,40.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,19.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.35,26.86,,,percent of total billed charges,26.86% of total billed charges,19.08,24,,,percent of total billed charges,24% of total billed charges ,24.8,31.2,,,percent of total billed charges,31.2% of total billed charges,63.6,80,,,percent of total billed charges,80% of total billed charges,19.08,24,,,percent of total billed charges,24% of total billed charges ,19.08,24,,,percent of total billed charges,24% of total billed charges ,19.08,63.6,
HEART/LUNG RESUSCITATION CPR,1792950,CDM,410,RC,92950,HCPCS,Outpatient,,,875.5,437.75,,235.16,26.86,,,percent of total billed charges,26.86% of total billed charges,656.63,75,,,percent of total billed charges,75% of total billed charges ,656.63,75,,,percent of total billed charges,75% of total billed charges ,210.12,24,,,percent of total billed charges,24% of total billed charges ,656.63,75,,,percent of total billed charges,75% of total billed charges ,656.63,75,,,percent of total billed charges,75% of total billed charges ,700.4,80,,,percent of total billed charges,80% of total billed charges ,212.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,441.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,656.63,75,,,percent of total billed charges,75% of total billed charges ,214.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,235.16,26.86,,,percent of total billed charges,26.86% of total billed charges,210.12,24,,,percent of total billed charges,24% of total billed charges ,273.16,31.2,,,percent of total billed charges,31.2% of total billed charges,700.4,80,,,percent of total billed charges,80% of total billed charges,210.12,24,,,percent of total billed charges,24% of total billed charges ,210.12,24,,,percent of total billed charges,24% of total billed charges ,210.12,700.4,
EVALUATE PT USE OF INHALER,1794664,CDM,410,RC,94664,HCPCS,Outpatient,,,592.5,296.25,,159.15,26.86,,,percent of total billed charges,26.86% of total billed charges,444.38,75,,,percent of total billed charges,75% of total billed charges ,444.38,75,,,percent of total billed charges,75% of total billed charges ,142.2,24,,,percent of total billed charges,24% of total billed charges ,444.38,75,,,percent of total billed charges,75% of total billed charges ,444.38,75,,,percent of total billed charges,75% of total billed charges ,474,80,,,percent of total billed charges,80% of total billed charges ,143.62,24.24,,,percent of total billed charges,24.24% of total billed charges ,298.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,444.38,75,,,percent of total billed charges,75% of total billed charges ,145.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,159.15,26.86,,,percent of total billed charges,26.86% of total billed charges,142.2,24,,,percent of total billed charges,24% of total billed charges ,184.86,31.2,,,percent of total billed charges,31.2% of total billed charges,474,80,,,percent of total billed charges,80% of total billed charges,142.2,24,,,percent of total billed charges,24% of total billed charges ,142.2,24,,,percent of total billed charges,24% of total billed charges ,142.2,474,
BREATHING CAPACITY TEST,1800010,CDM,460,RC,94010,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
EVALUATION OF WHEEZING TEST,1800020,CDM,460,RC,94060,HCPCS,Outpatient,,,399.5,199.75,,107.31,26.86,,,percent of total billed charges,26.86% of total billed charges,299.63,75,,,percent of total billed charges,75% of total billed charges ,299.63,75,,,percent of total billed charges,75% of total billed charges ,95.88,24,,,percent of total billed charges,24% of total billed charges ,299.63,75,,,percent of total billed charges,75% of total billed charges ,299.63,75,,,percent of total billed charges,75% of total billed charges ,319.6,80,,,percent of total billed charges,80% of total billed charges ,96.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,201.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,299.63,75,,,percent of total billed charges,75% of total billed charges ,97.8,24.48,,,percent of total billed charges,24.48% of total billed charges ,107.31,26.86,,,percent of total billed charges,26.86% of total billed charges,95.88,24,,,percent of total billed charges,24% of total billed charges ,124.64,31.2,,,percent of total billed charges,31.2% of total billed charges,319.6,80,,,percent of total billed charges,80% of total billed charges,95.88,24,,,percent of total billed charges,24% of total billed charges ,95.88,24,,,percent of total billed charges,24% of total billed charges ,95.88,319.6,
VITAL CAPACITY TEST,1800030,CDM,460,RC,94150,HCPCS,Outpatient,,,247,123.5,,66.34,26.86,,,percent of total billed charges,26.86% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,59.28,24,,,percent of total billed charges,24% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,197.6,80,,,percent of total billed charges,80% of total billed charges ,59.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,124.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,60.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,66.34,26.86,,,percent of total billed charges,26.86% of total billed charges,59.28,24,,,percent of total billed charges,24% of total billed charges ,77.06,31.2,,,percent of total billed charges,31.2% of total billed charges,197.6,80,,,percent of total billed charges,80% of total billed charges,59.28,24,,,percent of total billed charges,24% of total billed charges ,59.28,24,,,percent of total billed charges,24% of total billed charges ,59.28,197.6,
LUNG FUNCTION TEST,1800040,CDM,460,RC,94200,HCPCS,Outpatient,,,159.5,79.75,,42.84,26.86,,,percent of total billed charges,26.86% of total billed charges,119.63,75,,,percent of total billed charges,75% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,38.28,24,,,percent of total billed charges,24% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,127.6,80,,,percent of total billed charges,80% of total billed charges ,38.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,80.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,39.05,24.48,,,percent of total billed charges,24.48% of total billed charges ,42.84,26.86,,,percent of total billed charges,26.86% of total billed charges,38.28,24,,,percent of total billed charges,24% of total billed charges ,49.76,31.2,,,percent of total billed charges,31.2% of total billed charges,127.6,80,,,percent of total billed charges,80% of total billed charges,38.28,24,,,percent of total billed charges,24% of total billed charges ,38.28,24,,,percent of total billed charges,24% of total billed charges ,38.28,127.6,
RESPIRATORY FLOW VOLUME LOOP TEST,1800050,CDM,460,RC,94375,HCPCS,Outpatient,,,531.5,265.75,,142.76,26.86,,,percent of total billed charges,26.86% of total billed charges,398.63,75,,,percent of total billed charges,75% of total billed charges ,398.63,75,,,percent of total billed charges,75% of total billed charges ,127.56,24,,,percent of total billed charges,24% of total billed charges ,398.63,75,,,percent of total billed charges,75% of total billed charges ,398.63,75,,,percent of total billed charges,75% of total billed charges ,425.2,80,,,percent of total billed charges,80% of total billed charges ,128.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,267.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,398.63,75,,,percent of total billed charges,75% of total billed charges ,130.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,142.76,26.86,,,percent of total billed charges,26.86% of total billed charges,127.56,24,,,percent of total billed charges,24% of total billed charges ,165.83,31.2,,,percent of total billed charges,31.2% of total billed charges,425.2,80,,,percent of total billed charges,80% of total billed charges,127.56,24,,,percent of total billed charges,24% of total billed charges ,127.56,24,,,percent of total billed charges,24% of total billed charges ,127.56,425.2,
EXERCISE BRONCHOSPASM TEST,1800060,CDM,460,RC,94617,HCPCS,Outpatient,,,222.5,111.25,,59.76,26.86,,,percent of total billed charges,26.86% of total billed charges,166.88,75,,,percent of total billed charges,75% of total billed charges ,166.88,75,,,percent of total billed charges,75% of total billed charges ,53.4,24,,,percent of total billed charges,24% of total billed charges ,166.88,75,,,percent of total billed charges,75% of total billed charges ,166.88,75,,,percent of total billed charges,75% of total billed charges ,178,80,,,percent of total billed charges,80% of total billed charges ,53.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,166.88,75,,,percent of total billed charges,75% of total billed charges ,54.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.76,26.86,,,percent of total billed charges,26.86% of total billed charges,53.4,24,,,percent of total billed charges,24% of total billed charges ,69.42,31.2,,,percent of total billed charges,31.2% of total billed charges,178,80,,,percent of total billed charges,80% of total billed charges,53.4,24,,,percent of total billed charges,24% of total billed charges ,53.4,24,,,percent of total billed charges,24% of total billed charges ,53.4,178,
PULMONARY STRESS TEST,1800070,CDM,460,RC,94618,HCPCS,Outpatient,,,265.5,132.75,,71.31,26.86,,,percent of total billed charges,26.86% of total billed charges,199.13,75,,,percent of total billed charges,75% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,63.72,24,,,percent of total billed charges,24% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,212.4,80,,,percent of total billed charges,80% of total billed charges ,64.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,133.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,64.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,71.31,26.86,,,percent of total billed charges,26.86% of total billed charges,63.72,24,,,percent of total billed charges,24% of total billed charges ,82.84,31.2,,,percent of total billed charges,31.2% of total billed charges,212.4,80,,,percent of total billed charges,80% of total billed charges,63.72,24,,,percent of total billed charges,24% of total billed charges ,63.72,24,,,percent of total billed charges,24% of total billed charges ,63.72,212.4,
CARDIOPULMONARY EXERCISE TESTING,1800080,CDM,460,RC,94621,HCPCS,Outpatient,,,478,239,,128.39,26.86,,,percent of total billed charges,26.86% of total billed charges,358.5,75,,,percent of total billed charges,75% of total billed charges ,358.5,75,,,percent of total billed charges,75% of total billed charges ,114.72,24,,,percent of total billed charges,24% of total billed charges ,358.5,75,,,percent of total billed charges,75% of total billed charges ,358.5,75,,,percent of total billed charges,75% of total billed charges ,382.4,80,,,percent of total billed charges,80% of total billed charges ,115.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,240.91,50.4,,,percent of total billed charges,50.4% of total billed charges ,358.5,75,,,percent of total billed charges,75% of total billed charges ,117.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,128.39,26.86,,,percent of total billed charges,26.86% of total billed charges,114.72,24,,,percent of total billed charges,24% of total billed charges ,149.14,31.2,,,percent of total billed charges,31.2% of total billed charges,382.4,80,,,percent of total billed charges,80% of total billed charges,114.72,24,,,percent of total billed charges,24% of total billed charges ,114.72,24,,,percent of total billed charges,24% of total billed charges ,114.72,382.4,
AIRWAY INHALATION TREATMENT,1800100,CDM,410,RC,94640,HCPCS,Outpatient,,,328.5,164.25,,88.24,26.86,,,percent of total billed charges,26.86% of total billed charges,246.38,75,,,percent of total billed charges,75% of total billed charges ,246.38,75,,,percent of total billed charges,75% of total billed charges ,78.84,24,,,percent of total billed charges,24% of total billed charges ,246.38,75,,,percent of total billed charges,75% of total billed charges ,246.38,75,,,percent of total billed charges,75% of total billed charges ,262.8,80,,,percent of total billed charges,80% of total billed charges ,79.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,165.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,246.38,75,,,percent of total billed charges,75% of total billed charges ,80.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,88.24,26.86,,,percent of total billed charges,26.86% of total billed charges,78.84,24,,,percent of total billed charges,24% of total billed charges ,102.49,31.2,,,percent of total billed charges,31.2% of total billed charges,262.8,80,,,percent of total billed charges,80% of total billed charges,78.84,24,,,percent of total billed charges,24% of total billed charges ,78.84,24,,,percent of total billed charges,24% of total billed charges ,78.84,262.8,
EVALUATE PATIENT USE OF INHALER MDI,1800110,CDM,410,RC,94664,HCPCS,Outpatient,,,356.5,178.25,,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,285.2,
CHEST WALL MANIPULATION INITIAL,1800120,CDM,410,RC,94667,HCPCS,Outpatient,,,195.5,97.75,,52.51,26.86,,,percent of total billed charges,26.86% of total billed charges,146.63,75,,,percent of total billed charges,75% of total billed charges ,146.63,75,,,percent of total billed charges,75% of total billed charges ,46.92,24,,,percent of total billed charges,24% of total billed charges ,146.63,75,,,percent of total billed charges,75% of total billed charges ,146.63,75,,,percent of total billed charges,75% of total billed charges ,156.4,80,,,percent of total billed charges,80% of total billed charges ,47.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,98.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,146.63,75,,,percent of total billed charges,75% of total billed charges ,47.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,52.51,26.86,,,percent of total billed charges,26.86% of total billed charges,46.92,24,,,percent of total billed charges,24% of total billed charges ,61,31.2,,,percent of total billed charges,31.2% of total billed charges,156.4,80,,,percent of total billed charges,80% of total billed charges,46.92,24,,,percent of total billed charges,24% of total billed charges ,46.92,24,,,percent of total billed charges,24% of total billed charges ,46.92,156.4,
CHEST WALL MANIPULATION SUBSEQUENT,1800130,CDM,410,RC,94668,HCPCS,Outpatient,,,195.5,97.75,,52.51,26.86,,,percent of total billed charges,26.86% of total billed charges,146.63,75,,,percent of total billed charges,75% of total billed charges ,146.63,75,,,percent of total billed charges,75% of total billed charges ,46.92,24,,,percent of total billed charges,24% of total billed charges ,146.63,75,,,percent of total billed charges,75% of total billed charges ,146.63,75,,,percent of total billed charges,75% of total billed charges ,156.4,80,,,percent of total billed charges,80% of total billed charges ,47.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,98.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,146.63,75,,,percent of total billed charges,75% of total billed charges ,47.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,52.51,26.86,,,percent of total billed charges,26.86% of total billed charges,46.92,24,,,percent of total billed charges,24% of total billed charges ,61,31.2,,,percent of total billed charges,31.2% of total billed charges,156.4,80,,,percent of total billed charges,80% of total billed charges,46.92,24,,,percent of total billed charges,24% of total billed charges ,46.92,24,,,percent of total billed charges,24% of total billed charges ,46.92,156.4,
MECHANICAL CHEST WALL OSCILLATION,1800140,CDM,410,RC,94669,HCPCS,Outpatient,,,328.5,164.25,,88.24,26.86,,,percent of total billed charges,26.86% of total billed charges,246.38,75,,,percent of total billed charges,75% of total billed charges ,246.38,75,,,percent of total billed charges,75% of total billed charges ,78.84,24,,,percent of total billed charges,24% of total billed charges ,246.38,75,,,percent of total billed charges,75% of total billed charges ,246.38,75,,,percent of total billed charges,75% of total billed charges ,262.8,80,,,percent of total billed charges,80% of total billed charges ,79.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,165.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,246.38,75,,,percent of total billed charges,75% of total billed charges ,80.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,88.24,26.86,,,percent of total billed charges,26.86% of total billed charges,78.84,24,,,percent of total billed charges,24% of total billed charges ,102.49,31.2,,,percent of total billed charges,31.2% of total billed charges,262.8,80,,,percent of total billed charges,80% of total billed charges,78.84,24,,,percent of total billed charges,24% of total billed charges ,78.84,24,,,percent of total billed charges,24% of total billed charges ,78.84,262.8,
PULMONARY SERVICE PROCEDURE PER HOUR,1800150,CDM,410,RC,94799,HCPCS,Outpatient,,,248,124,,66.61,26.86,,,percent of total billed charges,26.86% of total billed charges,186,75,,,percent of total billed charges,75% of total billed charges ,186,75,,,percent of total billed charges,75% of total billed charges ,59.52,24,,,percent of total billed charges,24% of total billed charges ,186,75,,,percent of total billed charges,75% of total billed charges ,186,75,,,percent of total billed charges,75% of total billed charges ,198.4,80,,,percent of total billed charges,80% of total billed charges ,60.12,24.24,,,percent of total billed charges,24.24% of total billed charges ,124.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,186,75,,,percent of total billed charges,75% of total billed charges ,60.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,66.61,26.86,,,percent of total billed charges,26.86% of total billed charges,59.52,24,,,percent of total billed charges,24% of total billed charges ,77.38,31.2,,,percent of total billed charges,31.2% of total billed charges,198.4,80,,,percent of total billed charges,80% of total billed charges,59.52,24,,,percent of total billed charges,24% of total billed charges ,59.52,24,,,percent of total billed charges,24% of total billed charges ,59.52,198.4,
THERAPEUTIC PROCEDURE STRENGTH ENDURANCE,1800200,CDM,410,RC,G0237,HCPCS,Outpatient,,,68,34,,18.26,26.86,,,percent of total billed charges,26.86% of total billed charges,51,75,,,percent of total billed charges,75% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,16.32,24,,,percent of total billed charges,24% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,54.4,80,,,percent of total billed charges,80% of total billed charges ,16.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,16.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.26,26.86,,,percent of total billed charges,26.86% of total billed charges,16.32,24,,,percent of total billed charges,24% of total billed charges ,21.22,31.2,,,percent of total billed charges,31.2% of total billed charges,54.4,80,,,percent of total billed charges,80% of total billed charges,16.32,24,,,percent of total billed charges,24% of total billed charges ,16.32,24,,,percent of total billed charges,24% of total billed charges ,16.32,54.4,
OTHER RESPIRATORY PROCEDURE INDIVIDUAL,1800210,CDM,410,RC,G0238,HCPCS,Outpatient,,,68,34,,18.26,26.86,,,percent of total billed charges,26.86% of total billed charges,51,75,,,percent of total billed charges,75% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,16.32,24,,,percent of total billed charges,24% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,54.4,80,,,percent of total billed charges,80% of total billed charges ,16.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,16.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.26,26.86,,,percent of total billed charges,26.86% of total billed charges,16.32,24,,,percent of total billed charges,24% of total billed charges ,21.22,31.2,,,percent of total billed charges,31.2% of total billed charges,54.4,80,,,percent of total billed charges,80% of total billed charges,16.32,24,,,percent of total billed charges,24% of total billed charges ,16.32,24,,,percent of total billed charges,24% of total billed charges ,16.32,54.4,
OTHER RESPIRATORY PROCEDURE GROUP,1800220,CDM,410,RC,G0239,HCPCS,Outpatient,,,68,34,,18.26,26.86,,,percent of total billed charges,26.86% of total billed charges,51,75,,,percent of total billed charges,75% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,16.32,24,,,percent of total billed charges,24% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,54.4,80,,,percent of total billed charges,80% of total billed charges ,16.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,16.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.26,26.86,,,percent of total billed charges,26.86% of total billed charges,16.32,24,,,percent of total billed charges,24% of total billed charges ,21.22,31.2,,,percent of total billed charges,31.2% of total billed charges,54.4,80,,,percent of total billed charges,80% of total billed charges,16.32,24,,,percent of total billed charges,24% of total billed charges ,16.32,24,,,percent of total billed charges,24% of total billed charges ,16.32,54.4,
PULMONARY REHAB W/ AEROBIC EXER PER HOUR,1800230,CDM,948,RC,G0424,HCPCS,Outpatient,,,118.5,59.25,,31.83,26.86,,,percent of total billed charges,26.86% of total billed charges,88.88,75,,,percent of total billed charges,75% of total billed charges ,88.88,75,,,percent of total billed charges,75% of total billed charges ,28.44,24,,,percent of total billed charges,24% of total billed charges ,88.88,75,,,percent of total billed charges,75% of total billed charges ,88.88,75,,,percent of total billed charges,75% of total billed charges ,94.8,80,,,percent of total billed charges,80% of total billed charges ,28.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,59.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,88.88,75,,,percent of total billed charges,75% of total billed charges ,29.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.83,26.86,,,percent of total billed charges,26.86% of total billed charges,28.44,24,,,percent of total billed charges,24% of total billed charges ,36.97,31.2,,,percent of total billed charges,31.2% of total billed charges,94.8,80,,,percent of total billed charges,80% of total billed charges,28.44,24,,,percent of total billed charges,24% of total billed charges ,28.44,24,,,percent of total billed charges,24% of total billed charges ,28.44,94.8,
AIRWAY INHALATION TREATMENT,1894640,CDM,460,RC,94640,HCPCS,Outpatient,,,520,260,,139.67,26.86,,,percent of total billed charges,26.86% of total billed charges,390,75,,,percent of total billed charges,75% of total billed charges ,390,75,,,percent of total billed charges,75% of total billed charges ,124.8,24,,,percent of total billed charges,24% of total billed charges ,390,75,,,percent of total billed charges,75% of total billed charges ,390,75,,,percent of total billed charges,75% of total billed charges ,416,80,,,percent of total billed charges,80% of total billed charges ,126.05,24.24,,,percent of total billed charges,24.24% of total billed charges ,262.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,390,75,,,percent of total billed charges,75% of total billed charges ,127.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,139.67,26.86,,,percent of total billed charges,26.86% of total billed charges,124.8,24,,,percent of total billed charges,24% of total billed charges ,162.24,31.2,,,percent of total billed charges,31.2% of total billed charges,416,80,,,percent of total billed charges,80% of total billed charges,124.8,24,,,percent of total billed charges,24% of total billed charges ,124.8,24,,,percent of total billed charges,24% of total billed charges ,124.8,416,
ESOPHAGEAL SPEED BAN,2100091,CDM,360,RC,,,Outpatient,,,2555.5,1277.75,,686.41,26.86,,,percent of total billed charges,26.86% of total billed charges,1916.63,75,,,percent of total billed charges,75% of total billed charges ,1916.63,75,,,percent of total billed charges,75% of total billed charges ,613.32,24,,,percent of total billed charges,24% of total billed charges ,1916.63,75,,,percent of total billed charges,75% of total billed charges ,1916.63,75,,,percent of total billed charges,75% of total billed charges ,2044.4,80,,,percent of total billed charges,80% of total billed charges ,619.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,1287.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,1916.63,75,,,percent of total billed charges,75% of total billed charges ,625.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,686.41,26.86,,,percent of total billed charges,26.86% of total billed charges,613.32,24,,,percent of total billed charges,24% of total billed charges ,797.32,31.2,,,percent of total billed charges,31.2% of total billed charges,2044.4,80,,,percent of total billed charges,80% of total billed charges,613.32,24,,,percent of total billed charges,24% of total billed charges ,613.32,24,,,percent of total billed charges,24% of total billed charges ,613.32,2044.4,
SCOPE EXAM ROOM CHGE,2111102,CDM,360,RC,,,Outpatient,,,2354.5,1177.25,,632.42,26.86,,,percent of total billed charges,26.86% of total billed charges,1765.88,75,,,percent of total billed charges,75% of total billed charges ,1765.88,75,,,percent of total billed charges,75% of total billed charges ,565.08,24,,,percent of total billed charges,24% of total billed charges ,1765.88,75,,,percent of total billed charges,75% of total billed charges ,1765.88,75,,,percent of total billed charges,75% of total billed charges ,1883.6,80,,,percent of total billed charges,80% of total billed charges ,570.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,1186.67,50.4,,,percent of total billed charges,50.4% of total billed charges ,1765.88,75,,,percent of total billed charges,75% of total billed charges ,576.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,632.42,26.86,,,percent of total billed charges,26.86% of total billed charges,565.08,24,,,percent of total billed charges,24% of total billed charges ,734.6,31.2,,,percent of total billed charges,31.2% of total billed charges,1883.6,80,,,percent of total billed charges,80% of total billed charges,565.08,24,,,percent of total billed charges,24% of total billed charges ,565.08,24,,,percent of total billed charges,24% of total billed charges ,565.08,1883.6,
O R ROOM 1ST 30MIN,2111119,CDM,360,RC,,,Outpatient,,,3531,1765.5,,948.43,26.86,,,percent of total billed charges,26.86% of total billed charges,2648.25,75,,,percent of total billed charges,75% of total billed charges ,2648.25,75,,,percent of total billed charges,75% of total billed charges ,847.44,24,,,percent of total billed charges,24% of total billed charges ,2648.25,75,,,percent of total billed charges,75% of total billed charges ,2648.25,75,,,percent of total billed charges,75% of total billed charges ,2824.8,80,,,percent of total billed charges,80% of total billed charges ,855.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,1779.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,2648.25,75,,,percent of total billed charges,75% of total billed charges ,864.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,948.43,26.86,,,percent of total billed charges,26.86% of total billed charges,847.44,24,,,percent of total billed charges,24% of total billed charges ,1101.67,31.2,,,percent of total billed charges,31.2% of total billed charges,2824.8,80,,,percent of total billed charges,80% of total billed charges,847.44,24,,,percent of total billed charges,24% of total billed charges ,847.44,24,,,percent of total billed charges,24% of total billed charges ,847.44,2824.8,
O R 1/4HR TIME CHRG,2111120,CDM,360,RC,,,Outpatient,,,589,294.5,,158.21,26.86,,,percent of total billed charges,26.86% of total billed charges,441.75,75,,,percent of total billed charges,75% of total billed charges ,441.75,75,,,percent of total billed charges,75% of total billed charges ,141.36,24,,,percent of total billed charges,24% of total billed charges ,441.75,75,,,percent of total billed charges,75% of total billed charges ,441.75,75,,,percent of total billed charges,75% of total billed charges ,471.2,80,,,percent of total billed charges,80% of total billed charges ,142.77,24.24,,,percent of total billed charges,24.24% of total billed charges ,296.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,441.75,75,,,percent of total billed charges,75% of total billed charges ,144.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,158.21,26.86,,,percent of total billed charges,26.86% of total billed charges,141.36,24,,,percent of total billed charges,24% of total billed charges ,183.77,31.2,,,percent of total billed charges,31.2% of total billed charges,471.2,80,,,percent of total billed charges,80% of total billed charges,141.36,24,,,percent of total billed charges,24% of total billed charges ,141.36,24,,,percent of total billed charges,24% of total billed charges ,141.36,471.2,
MINOR PROCEDURE <30,2111125,CDM,360,RC,,,Outpatient,,,941.5,470.75,,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,753.2,80,,,percent of total billed charges,80% of total billed charges ,228.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,474.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,230.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,293.75,31.2,,,percent of total billed charges,31.2% of total billed charges,753.2,80,,,percent of total billed charges,80% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,753.2,
ENDOSCOPE WITH LIGHT,2113035,CDM,360,RC,,,Outpatient,,,941.5,470.75,,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,753.2,80,,,percent of total billed charges,80% of total billed charges ,228.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,474.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,230.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,293.75,31.2,,,percent of total billed charges,31.2% of total billed charges,753.2,80,,,percent of total billed charges,80% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,753.2,
ARTHROSCOPE,2113050,CDM,360,RC,,,Outpatient,,,941.5,470.75,,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,753.2,80,,,percent of total billed charges,80% of total billed charges ,228.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,474.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,230.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,293.75,31.2,,,percent of total billed charges,31.2% of total billed charges,753.2,80,,,percent of total billed charges,80% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,753.2,
COLORECTAL SCREEN HI,2113150,CDM,360,RC,,,Outpatient,,,941.5,470.75,,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,753.2,80,,,percent of total billed charges,80% of total billed charges ,228.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,474.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,230.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,293.75,31.2,,,percent of total billed charges,31.2% of total billed charges,753.2,80,,,percent of total billed charges,80% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,753.2,
COLORECTAL SCRREN LO,2113160,CDM,360,RC,,,Outpatient,,,941.5,470.75,,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,753.2,80,,,percent of total billed charges,80% of total billed charges ,228.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,474.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,230.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,293.75,31.2,,,percent of total billed charges,31.2% of total billed charges,753.2,80,,,percent of total billed charges,80% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,753.2,
FLEX CYCTOSCOPE,2113210,CDM,360,RC,,,Outpatient,,,941.5,470.75,,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,753.2,80,,,percent of total billed charges,80% of total billed charges ,228.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,474.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,230.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,293.75,31.2,,,percent of total billed charges,31.2% of total billed charges,753.2,80,,,percent of total billed charges,80% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,753.2,
LAP CHOLE,2113234,CDM,360,RC,,,Outpatient,,,2824.5,1412.25,,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2259.6,80,,,percent of total billed charges,80% of total billed charges ,684.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,1423.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,691.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,881.24,31.2,,,percent of total billed charges,31.2% of total billed charges,2259.6,80,,,percent of total billed charges,80% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,2259.6,
CHOLEDUCTOSCOPE,2113265,CDM,360,RC,,,Outpatient,,,2824.5,1412.25,,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2259.6,80,,,percent of total billed charges,80% of total billed charges ,684.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,1423.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,691.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,881.24,31.2,,,percent of total billed charges,31.2% of total billed charges,2259.6,80,,,percent of total billed charges,80% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,2259.6,
LAPARSCOPIC HERNIA,2113266,CDM,360,RC,,,Outpatient,,,2824.5,1412.25,,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2259.6,80,,,percent of total billed charges,80% of total billed charges ,684.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,1423.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,691.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,881.24,31.2,,,percent of total billed charges,31.2% of total billed charges,2259.6,80,,,percent of total billed charges,80% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,2259.6,
ANGIOPLASTY ART BLKG,2113267,CDM,360,RC,36902,HCPCS,Outpatient,,,2824.5,1412.25,,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2259.6,80,,,percent of total billed charges,80% of total billed charges ,684.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,1423.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,691.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,881.24,31.2,,,percent of total billed charges,31.2% of total billed charges,2259.6,80,,,percent of total billed charges,80% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,2259.6,
ANGIOPLASTY VEN BLKG,2113268,CDM,360,RC,,,Outpatient,,,5870,2935,,1576.68,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,1408.8,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4696,80,,,percent of total billed charges,80% of total billed charges ,1422.89,24.24,,,percent of total billed charges,24.24% of total billed charges ,2958.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,4402.5,75,,,percent of total billed charges,75% of total billed charges ,1436.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,1576.68,26.86,,,percent of total billed charges,26.86% of total billed charges,1408.8,24,,,percent of total billed charges,24% of total billed charges ,1831.44,31.2,,,percent of total billed charges,31.2% of total billed charges,4696,80,,,percent of total billed charges,80% of total billed charges,1408.8,24,,,percent of total billed charges,24% of total billed charges ,1408.8,24,,,percent of total billed charges,24% of total billed charges ,1408.8,4696,
THROMBECT AV FISTULA,2113269,CDM,360,RC,36904,HCPCS,Outpatient,,,3764.5,1882.25,,1011.14,26.86,,,percent of total billed charges,26.86% of total billed charges,2823.38,75,,,percent of total billed charges,75% of total billed charges ,2823.38,75,,,percent of total billed charges,75% of total billed charges ,903.48,24,,,percent of total billed charges,24% of total billed charges ,2823.38,75,,,percent of total billed charges,75% of total billed charges ,2823.38,75,,,percent of total billed charges,75% of total billed charges ,3011.6,80,,,percent of total billed charges,80% of total billed charges ,912.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,1897.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,2823.38,75,,,percent of total billed charges,75% of total billed charges ,921.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,1011.14,26.86,,,percent of total billed charges,26.86% of total billed charges,903.48,24,,,percent of total billed charges,24% of total billed charges ,1174.52,31.2,,,percent of total billed charges,31.2% of total billed charges,3011.6,80,,,percent of total billed charges,80% of total billed charges,903.48,24,,,percent of total billed charges,24% of total billed charges ,903.48,24,,,percent of total billed charges,24% of total billed charges ,903.48,3011.6,
INSERT VEN ACC DEVIC,2113270,CDM,360,RC,36558,HCPCS,Outpatient,,,2824.5,1412.25,,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2259.6,80,,,percent of total billed charges,80% of total billed charges ,684.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,1423.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,691.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,881.24,31.2,,,percent of total billed charges,31.2% of total billed charges,2259.6,80,,,percent of total billed charges,80% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,2259.6,
REVISE VEN ACC DEVIC,2113271,CDM,360,RC,36581,HCPCS,Outpatient,,,1412,706,,379.26,26.86,,,percent of total billed charges,26.86% of total billed charges,1059,75,,,percent of total billed charges,75% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,338.88,24,,,percent of total billed charges,24% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,1129.6,80,,,percent of total billed charges,80% of total billed charges ,342.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,711.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,345.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,379.26,26.86,,,percent of total billed charges,26.86% of total billed charges,338.88,24,,,percent of total billed charges,24% of total billed charges ,440.54,31.2,,,percent of total billed charges,31.2% of total billed charges,1129.6,80,,,percent of total billed charges,80% of total billed charges,338.88,24,,,percent of total billed charges,24% of total billed charges ,338.88,24,,,percent of total billed charges,24% of total billed charges ,338.88,1129.6,
REMOVE VEN ACC DEVIC,2113272,CDM,360,RC,36589,HCPCS,Outpatient,,,1412,706,,379.26,26.86,,,percent of total billed charges,26.86% of total billed charges,1059,75,,,percent of total billed charges,75% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,338.88,24,,,percent of total billed charges,24% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,1129.6,80,,,percent of total billed charges,80% of total billed charges ,342.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,711.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,345.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,379.26,26.86,,,percent of total billed charges,26.86% of total billed charges,338.88,24,,,percent of total billed charges,24% of total billed charges ,440.54,31.2,,,percent of total billed charges,31.2% of total billed charges,1129.6,80,,,percent of total billed charges,80% of total billed charges,338.88,24,,,percent of total billed charges,24% of total billed charges ,338.88,24,,,percent of total billed charges,24% of total billed charges ,338.88,1129.6,
DECLOT VAS ACC DEVIC,2113273,CDM,360,RC,36593,HCPCS,Outpatient,,,753,376.5,,202.26,26.86,,,percent of total billed charges,26.86% of total billed charges,564.75,75,,,percent of total billed charges,75% of total billed charges ,564.75,75,,,percent of total billed charges,75% of total billed charges ,180.72,24,,,percent of total billed charges,24% of total billed charges ,564.75,75,,,percent of total billed charges,75% of total billed charges ,564.75,75,,,percent of total billed charges,75% of total billed charges ,602.4,80,,,percent of total billed charges,80% of total billed charges ,182.53,24.24,,,percent of total billed charges,24.24% of total billed charges ,379.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,564.75,75,,,percent of total billed charges,75% of total billed charges ,184.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,202.26,26.86,,,percent of total billed charges,26.86% of total billed charges,180.72,24,,,percent of total billed charges,24% of total billed charges ,234.94,31.2,,,percent of total billed charges,31.2% of total billed charges,602.4,80,,,percent of total billed charges,80% of total billed charges,180.72,24,,,percent of total billed charges,24% of total billed charges ,180.72,24,,,percent of total billed charges,24% of total billed charges ,180.72,602.4,
TRANSCATH PLACE STEN,2113274,CDM,360,RC,37236,HCPCS,Outpatient,,,3764.5,1882.25,,1011.14,26.86,,,percent of total billed charges,26.86% of total billed charges,2823.38,75,,,percent of total billed charges,75% of total billed charges ,2823.38,75,,,percent of total billed charges,75% of total billed charges ,903.48,24,,,percent of total billed charges,24% of total billed charges ,2823.38,75,,,percent of total billed charges,75% of total billed charges ,2823.38,75,,,percent of total billed charges,75% of total billed charges ,3011.6,80,,,percent of total billed charges,80% of total billed charges ,912.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,1897.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,2823.38,75,,,percent of total billed charges,75% of total billed charges ,921.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,1011.14,26.86,,,percent of total billed charges,26.86% of total billed charges,903.48,24,,,percent of total billed charges,24% of total billed charges ,1174.52,31.2,,,percent of total billed charges,31.2% of total billed charges,3011.6,80,,,percent of total billed charges,80% of total billed charges,903.48,24,,,percent of total billed charges,24% of total billed charges ,903.48,24,,,percent of total billed charges,24% of total billed charges ,903.48,3011.6,
ADDTL STENT PLACEMEN,2113275,CDM,360,RC,37237,HCPCS,Outpatient,,,3295,1647.5,,885.04,26.86,,,percent of total billed charges,26.86% of total billed charges,2471.25,75,,,percent of total billed charges,75% of total billed charges ,2471.25,75,,,percent of total billed charges,75% of total billed charges ,790.8,24,,,percent of total billed charges,24% of total billed charges ,2471.25,75,,,percent of total billed charges,75% of total billed charges ,2471.25,75,,,percent of total billed charges,75% of total billed charges ,2636,80,,,percent of total billed charges,80% of total billed charges ,798.71,24.24,,,percent of total billed charges,24.24% of total billed charges ,1660.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,2471.25,75,,,percent of total billed charges,75% of total billed charges ,806.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,885.04,26.86,,,percent of total billed charges,26.86% of total billed charges,790.8,24,,,percent of total billed charges,24% of total billed charges ,1028.04,31.2,,,percent of total billed charges,31.2% of total billed charges,2636,80,,,percent of total billed charges,80% of total billed charges,790.8,24,,,percent of total billed charges,24% of total billed charges ,790.8,24,,,percent of total billed charges,24% of total billed charges ,790.8,2636,
EXCH ART CATH,2113276,CDM,360,RC,37211,HCPCS,Outpatient,,,1317.5,658.75,,353.88,26.86,,,percent of total billed charges,26.86% of total billed charges,988.13,75,,,percent of total billed charges,75% of total billed charges ,988.13,75,,,percent of total billed charges,75% of total billed charges ,316.2,24,,,percent of total billed charges,24% of total billed charges ,988.13,75,,,percent of total billed charges,75% of total billed charges ,988.13,75,,,percent of total billed charges,75% of total billed charges ,1054,80,,,percent of total billed charges,80% of total billed charges ,319.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,664.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,988.13,75,,,percent of total billed charges,75% of total billed charges ,322.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,353.88,26.86,,,percent of total billed charges,26.86% of total billed charges,316.2,24,,,percent of total billed charges,24% of total billed charges ,411.06,31.2,,,percent of total billed charges,31.2% of total billed charges,1054,80,,,percent of total billed charges,80% of total billed charges,316.2,24,,,percent of total billed charges,24% of total billed charges ,316.2,24,,,percent of total billed charges,24% of total billed charges ,316.2,1054,
PARTIAL REPLACE VAD,2113277,CDM,360,RC,36578,HCPCS,Outpatient,,,1412,706,,379.26,26.86,,,percent of total billed charges,26.86% of total billed charges,1059,75,,,percent of total billed charges,75% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,338.88,24,,,percent of total billed charges,24% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,1129.6,80,,,percent of total billed charges,80% of total billed charges ,342.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,711.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,345.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,379.26,26.86,,,percent of total billed charges,26.86% of total billed charges,338.88,24,,,percent of total billed charges,24% of total billed charges ,440.54,31.2,,,percent of total billed charges,31.2% of total billed charges,1129.6,80,,,percent of total billed charges,80% of total billed charges,338.88,24,,,percent of total billed charges,24% of total billed charges ,338.88,24,,,percent of total billed charges,24% of total billed charges ,338.88,1129.6,
INJ EXT VENOGRAPHY,2113278,CDM,360,RC,36005,HCPCS,Outpatient,,,564.5,282.25,,151.62,26.86,,,percent of total billed charges,26.86% of total billed charges,423.38,75,,,percent of total billed charges,75% of total billed charges ,423.38,75,,,percent of total billed charges,75% of total billed charges ,135.48,24,,,percent of total billed charges,24% of total billed charges ,423.38,75,,,percent of total billed charges,75% of total billed charges ,423.38,75,,,percent of total billed charges,75% of total billed charges ,451.6,80,,,percent of total billed charges,80% of total billed charges ,136.83,24.24,,,percent of total billed charges,24.24% of total billed charges ,284.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,423.38,75,,,percent of total billed charges,75% of total billed charges ,138.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,151.62,26.86,,,percent of total billed charges,26.86% of total billed charges,135.48,24,,,percent of total billed charges,24% of total billed charges ,176.12,31.2,,,percent of total billed charges,31.2% of total billed charges,451.6,80,,,percent of total billed charges,80% of total billed charges,135.48,24,,,percent of total billed charges,24% of total billed charges ,135.48,24,,,percent of total billed charges,24% of total billed charges ,135.48,451.6,
INJECT ANTIOBOTIC IM,2113279,CDM,260,RC,,,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
LIGATION AV FISTULA,2113280,CDM,360,RC,37607,HCPCS,Outpatient,,,2824.5,1412.25,,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2259.6,80,,,percent of total billed charges,80% of total billed charges ,684.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,1423.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,691.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,881.24,31.2,,,percent of total billed charges,31.2% of total billed charges,2259.6,80,,,percent of total billed charges,80% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,2259.6,
I&D PERIGRAFT SEROMA,2113281,CDM,360,RC,37799,HCPCS,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
CANNULATION OF GRAFT,2113282,CDM,360,RC,36800,HCPCS,Outpatient,,,3388.5,1694.25,,910.15,26.86,,,percent of total billed charges,26.86% of total billed charges,2541.38,75,,,percent of total billed charges,75% of total billed charges ,2541.38,75,,,percent of total billed charges,75% of total billed charges ,813.24,24,,,percent of total billed charges,24% of total billed charges ,2541.38,75,,,percent of total billed charges,75% of total billed charges ,2541.38,75,,,percent of total billed charges,75% of total billed charges ,2710.8,80,,,percent of total billed charges,80% of total billed charges ,821.37,24.24,,,percent of total billed charges,24.24% of total billed charges ,1707.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,2541.38,75,,,percent of total billed charges,75% of total billed charges ,829.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,910.15,26.86,,,percent of total billed charges,26.86% of total billed charges,813.24,24,,,percent of total billed charges,24% of total billed charges ,1057.21,31.2,,,percent of total billed charges,31.2% of total billed charges,2710.8,80,,,percent of total billed charges,80% of total billed charges,813.24,24,,,percent of total billed charges,24% of total billed charges ,813.24,24,,,percent of total billed charges,24% of total billed charges ,813.24,2710.8,
I&D HEMATOMA PERIGRA,2113283,CDM,360,RC,37799,HCPCS,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
INSERTION PICC LINE,2113284,CDM,360,RC,36569,HCPCS,Outpatient,,,1412,706,,379.26,26.86,,,percent of total billed charges,26.86% of total billed charges,1059,75,,,percent of total billed charges,75% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,338.88,24,,,percent of total billed charges,24% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,1129.6,80,,,percent of total billed charges,80% of total billed charges ,342.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,711.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,345.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,379.26,26.86,,,percent of total billed charges,26.86% of total billed charges,338.88,24,,,percent of total billed charges,24% of total billed charges ,440.54,31.2,,,percent of total billed charges,31.2% of total billed charges,1129.6,80,,,percent of total billed charges,80% of total billed charges,338.88,24,,,percent of total billed charges,24% of total billed charges ,338.88,24,,,percent of total billed charges,24% of total billed charges ,338.88,1129.6,
SHUNT ARTERY TO VEIN,2113285,CDM,360,RC,37182,HCPCS,Outpatient,,,3764.5,1882.25,,1011.14,26.86,,,percent of total billed charges,26.86% of total billed charges,2823.38,75,,,percent of total billed charges,75% of total billed charges ,2823.38,75,,,percent of total billed charges,75% of total billed charges ,903.48,24,,,percent of total billed charges,24% of total billed charges ,2823.38,75,,,percent of total billed charges,75% of total billed charges ,2823.38,75,,,percent of total billed charges,75% of total billed charges ,3011.6,80,,,percent of total billed charges,80% of total billed charges ,912.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,1897.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,2823.38,75,,,percent of total billed charges,75% of total billed charges ,921.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,1011.14,26.86,,,percent of total billed charges,26.86% of total billed charges,903.48,24,,,percent of total billed charges,24% of total billed charges ,1174.52,31.2,,,percent of total billed charges,31.2% of total billed charges,3011.6,80,,,percent of total billed charges,80% of total billed charges,903.48,24,,,percent of total billed charges,24% of total billed charges ,903.48,24,,,percent of total billed charges,24% of total billed charges ,903.48,3011.6,
ART EXT-ARM,2113286,CDM,921,RC,93922,HCPCS,Outpatient,,,1883,941.5,,505.77,26.86,,,percent of total billed charges,26.86% of total billed charges,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,451.92,24,,,percent of total billed charges,24% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1506.4,80,,,percent of total billed charges,80% of total billed charges ,456.44,24.24,,,percent of total billed charges,24.24% of total billed charges ,949.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,460.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,505.77,26.86,,,percent of total billed charges,26.86% of total billed charges,451.92,24,,,percent of total billed charges,24% of total billed charges ,587.5,31.2,,,percent of total billed charges,31.2% of total billed charges,1506.4,80,,,percent of total billed charges,80% of total billed charges,451.92,24,,,percent of total billed charges,24% of total billed charges ,451.92,24,,,percent of total billed charges,24% of total billed charges ,451.92,1506.4,
SVC OR IVC PLACEMENT,2113287,CDM,360,RC,36010,HCPCS,Outpatient,,,1883,941.5,,505.77,26.86,,,percent of total billed charges,26.86% of total billed charges,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,451.92,24,,,percent of total billed charges,24% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1506.4,80,,,percent of total billed charges,80% of total billed charges ,456.44,24.24,,,percent of total billed charges,24.24% of total billed charges ,949.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,460.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,505.77,26.86,,,percent of total billed charges,26.86% of total billed charges,451.92,24,,,percent of total billed charges,24% of total billed charges ,587.5,31.2,,,percent of total billed charges,31.2% of total billed charges,1506.4,80,,,percent of total billed charges,80% of total billed charges,451.92,24,,,percent of total billed charges,24% of total billed charges ,451.92,24,,,percent of total billed charges,24% of total billed charges ,451.92,1506.4,
REVISION AV FISTULA,2113288,CDM,360,RC,36010,HCPCS,Outpatient,,,1317.5,658.75,,353.88,26.86,,,percent of total billed charges,26.86% of total billed charges,988.13,75,,,percent of total billed charges,75% of total billed charges ,988.13,75,,,percent of total billed charges,75% of total billed charges ,316.2,24,,,percent of total billed charges,24% of total billed charges ,988.13,75,,,percent of total billed charges,75% of total billed charges ,988.13,75,,,percent of total billed charges,75% of total billed charges ,1054,80,,,percent of total billed charges,80% of total billed charges ,319.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,664.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,988.13,75,,,percent of total billed charges,75% of total billed charges ,322.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,353.88,26.86,,,percent of total billed charges,26.86% of total billed charges,316.2,24,,,percent of total billed charges,24% of total billed charges ,411.06,31.2,,,percent of total billed charges,31.2% of total billed charges,1054,80,,,percent of total billed charges,80% of total billed charges,316.2,24,,,percent of total billed charges,24% of total billed charges ,316.2,24,,,percent of total billed charges,24% of total billed charges ,316.2,1054,
INSERT TUNNELED CVA,2113289,CDM,360,RC,36565,HCPCS,Outpatient,,,1883,941.5,,505.77,26.86,,,percent of total billed charges,26.86% of total billed charges,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,451.92,24,,,percent of total billed charges,24% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1506.4,80,,,percent of total billed charges,80% of total billed charges ,456.44,24.24,,,percent of total billed charges,24.24% of total billed charges ,949.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,460.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,505.77,26.86,,,percent of total billed charges,26.86% of total billed charges,451.92,24,,,percent of total billed charges,24% of total billed charges ,587.5,31.2,,,percent of total billed charges,31.2% of total billed charges,1506.4,80,,,percent of total billed charges,80% of total billed charges,451.92,24,,,percent of total billed charges,24% of total billed charges ,451.92,24,,,percent of total billed charges,24% of total billed charges ,451.92,1506.4,
REMOVAL FOREIGN BODY,2113290,CDM,360,RC,20520,HCPCS,Outpatient,,,377,188.5,,101.26,26.86,,,percent of total billed charges,26.86% of total billed charges,282.75,75,,,percent of total billed charges,75% of total billed charges ,282.75,75,,,percent of total billed charges,75% of total billed charges ,90.48,24,,,percent of total billed charges,24% of total billed charges ,282.75,75,,,percent of total billed charges,75% of total billed charges ,282.75,75,,,percent of total billed charges,75% of total billed charges ,301.6,80,,,percent of total billed charges,80% of total billed charges ,91.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,190.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,282.75,75,,,percent of total billed charges,75% of total billed charges ,92.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,101.26,26.86,,,percent of total billed charges,26.86% of total billed charges,90.48,24,,,percent of total billed charges,24% of total billed charges ,117.62,31.2,,,percent of total billed charges,31.2% of total billed charges,301.6,80,,,percent of total billed charges,80% of total billed charges,90.48,24,,,percent of total billed charges,24% of total billed charges ,90.48,24,,,percent of total billed charges,24% of total billed charges ,90.48,301.6,
A/V ANASTOMOSIS OPEN,2113291,CDM,360,RC,36818,HCPCS,Outpatient,,,1883,941.5,,505.77,26.86,,,percent of total billed charges,26.86% of total billed charges,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,451.92,24,,,percent of total billed charges,24% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1506.4,80,,,percent of total billed charges,80% of total billed charges ,456.44,24.24,,,percent of total billed charges,24.24% of total billed charges ,949.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,460.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,505.77,26.86,,,percent of total billed charges,26.86% of total billed charges,451.92,24,,,percent of total billed charges,24% of total billed charges ,587.5,31.2,,,percent of total billed charges,31.2% of total billed charges,1506.4,80,,,percent of total billed charges,80% of total billed charges,451.92,24,,,percent of total billed charges,24% of total billed charges ,451.92,24,,,percent of total billed charges,24% of total billed charges ,451.92,1506.4,
INTER INF VENA CAVA,2113292,CDM,360,RC,37191,HCPCS,Outpatient,,,2824.5,1412.25,,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2259.6,80,,,percent of total billed charges,80% of total billed charges ,684.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,1423.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,691.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,881.24,31.2,,,percent of total billed charges,31.2% of total billed charges,2259.6,80,,,percent of total billed charges,80% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,2259.6,
TRANSCATH RETR FB,2113293,CDM,360,RC,37197,HCPCS,Outpatient,,,1835.5,917.75,,493.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1376.63,75,,,percent of total billed charges,75% of total billed charges ,1376.63,75,,,percent of total billed charges,75% of total billed charges ,440.52,24,,,percent of total billed charges,24% of total billed charges ,1376.63,75,,,percent of total billed charges,75% of total billed charges ,1376.63,75,,,percent of total billed charges,75% of total billed charges ,1468.4,80,,,percent of total billed charges,80% of total billed charges ,444.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,925.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,1376.63,75,,,percent of total billed charges,75% of total billed charges ,449.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,493.02,26.86,,,percent of total billed charges,26.86% of total billed charges,440.52,24,,,percent of total billed charges,24% of total billed charges ,572.68,31.2,,,percent of total billed charges,31.2% of total billed charges,1468.4,80,,,percent of total billed charges,80% of total billed charges,440.52,24,,,percent of total billed charges,24% of total billed charges ,440.52,24,,,percent of total billed charges,24% of total billed charges ,440.52,1468.4,
CATH ART PLACEMENT,2113294,CDM,360,RC,36246,HCPCS,Outpatient,,,1883,941.5,,505.77,26.86,,,percent of total billed charges,26.86% of total billed charges,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,451.92,24,,,percent of total billed charges,24% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1506.4,80,,,percent of total billed charges,80% of total billed charges ,456.44,24.24,,,percent of total billed charges,24.24% of total billed charges ,949.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,460.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,505.77,26.86,,,percent of total billed charges,26.86% of total billed charges,451.92,24,,,percent of total billed charges,24% of total billed charges ,587.5,31.2,,,percent of total billed charges,31.2% of total billed charges,1506.4,80,,,percent of total billed charges,80% of total billed charges,451.92,24,,,percent of total billed charges,24% of total billed charges ,451.92,24,,,percent of total billed charges,24% of total billed charges ,451.92,1506.4,
VESSEL MAPPING DIALY,2113295,CDM,920,RC,93990,HCPCS,Outpatient,,,941.5,470.75,,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,753.2,80,,,percent of total billed charges,80% of total billed charges ,228.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,474.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,230.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,293.75,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,753.2,
REPAIR ANEURYSM,2113296,CDM,360,RC,35011,HCPCS,Outpatient,,,2824.5,1412.25,,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2259.6,80,,,percent of total billed charges,80% of total billed charges ,684.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,1423.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,691.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,881.24,31.2,,,percent of total billed charges,31.2% of total billed charges,2259.6,80,,,percent of total billed charges,80% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,2259.6,
REP BLD VESS W/GRAFT,2113297,CDM,360,RC,35266,HCPCS,Outpatient,,,2259,1129.5,,606.77,26.86,,,percent of total billed charges,26.86% of total billed charges,1694.25,75,,,percent of total billed charges,75% of total billed charges ,1694.25,75,,,percent of total billed charges,75% of total billed charges ,542.16,24,,,percent of total billed charges,24% of total billed charges ,1694.25,75,,,percent of total billed charges,75% of total billed charges ,1694.25,75,,,percent of total billed charges,75% of total billed charges ,1807.2,80,,,percent of total billed charges,80% of total billed charges ,547.58,24.24,,,percent of total billed charges,24.24% of total billed charges ,1138.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,1694.25,75,,,percent of total billed charges,75% of total billed charges ,553,24.48,,,percent of total billed charges,24.48% of total billed charges ,606.77,26.86,,,percent of total billed charges,26.86% of total billed charges,542.16,24,,,percent of total billed charges,24% of total billed charges ,704.81,31.2,,,percent of total billed charges,31.2% of total billed charges,1807.2,80,,,percent of total billed charges,80% of total billed charges,542.16,24,,,percent of total billed charges,24% of total billed charges ,542.16,24,,,percent of total billed charges,24% of total billed charges ,542.16,1807.2,
REV ART BYPASS W/O,2113298,CDM,360,RC,35881,HCPCS,Outpatient,,,1883,941.5,,505.77,26.86,,,percent of total billed charges,26.86% of total billed charges,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,451.92,24,,,percent of total billed charges,24% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,1506.4,80,,,percent of total billed charges,80% of total billed charges ,456.44,24.24,,,percent of total billed charges,24.24% of total billed charges ,949.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,1412.25,75,,,percent of total billed charges,75% of total billed charges ,460.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,505.77,26.86,,,percent of total billed charges,26.86% of total billed charges,451.92,24,,,percent of total billed charges,24% of total billed charges ,587.5,31.2,,,percent of total billed charges,31.2% of total billed charges,1506.4,80,,,percent of total billed charges,80% of total billed charges,451.92,24,,,percent of total billed charges,24% of total billed charges ,451.92,24,,,percent of total billed charges,24% of total billed charges ,451.92,1506.4,
ANGIOPLASTY FEM-POP,2113299,CDM,360,RC,37224,HCPCS,Outpatient,,,2730.5,1365.25,,733.41,26.86,,,percent of total billed charges,26.86% of total billed charges,2047.88,75,,,percent of total billed charges,75% of total billed charges ,2047.88,75,,,percent of total billed charges,75% of total billed charges ,655.32,24,,,percent of total billed charges,24% of total billed charges ,2047.88,75,,,percent of total billed charges,75% of total billed charges ,2047.88,75,,,percent of total billed charges,75% of total billed charges ,2184.4,80,,,percent of total billed charges,80% of total billed charges ,661.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,1376.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,2047.88,75,,,percent of total billed charges,75% of total billed charges ,668.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,733.41,26.86,,,percent of total billed charges,26.86% of total billed charges,655.32,24,,,percent of total billed charges,24% of total billed charges ,851.92,31.2,,,percent of total billed charges,31.2% of total billed charges,2184.4,80,,,percent of total billed charges,80% of total billed charges,655.32,24,,,percent of total billed charges,24% of total billed charges ,655.32,24,,,percent of total billed charges,24% of total billed charges ,655.32,2184.4,
ENDOVENOUS ABLATION,2113300,CDM,360,RC,36478,HCPCS,Outpatient,,,753,376.5,,202.26,26.86,,,percent of total billed charges,26.86% of total billed charges,564.75,75,,,percent of total billed charges,75% of total billed charges ,564.75,75,,,percent of total billed charges,75% of total billed charges ,180.72,24,,,percent of total billed charges,24% of total billed charges ,564.75,75,,,percent of total billed charges,75% of total billed charges ,564.75,75,,,percent of total billed charges,75% of total billed charges ,602.4,80,,,percent of total billed charges,80% of total billed charges ,182.53,24.24,,,percent of total billed charges,24.24% of total billed charges ,379.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,564.75,75,,,percent of total billed charges,75% of total billed charges ,184.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,202.26,26.86,,,percent of total billed charges,26.86% of total billed charges,180.72,24,,,percent of total billed charges,24% of total billed charges ,234.94,31.2,,,percent of total billed charges,31.2% of total billed charges,602.4,80,,,percent of total billed charges,80% of total billed charges,180.72,24,,,percent of total billed charges,24% of total billed charges ,180.72,24,,,percent of total billed charges,24% of total billed charges ,180.72,602.4,
INTRO CATH AORTA,2113301,CDM,360,RC,36200,HCPCS,Outpatient,,,1835.5,917.75,,493.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1376.63,75,,,percent of total billed charges,75% of total billed charges ,1376.63,75,,,percent of total billed charges,75% of total billed charges ,440.52,24,,,percent of total billed charges,24% of total billed charges ,1376.63,75,,,percent of total billed charges,75% of total billed charges ,1376.63,75,,,percent of total billed charges,75% of total billed charges ,1468.4,80,,,percent of total billed charges,80% of total billed charges ,444.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,925.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,1376.63,75,,,percent of total billed charges,75% of total billed charges ,449.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,493.02,26.86,,,percent of total billed charges,26.86% of total billed charges,440.52,24,,,percent of total billed charges,24% of total billed charges ,572.68,31.2,,,percent of total billed charges,31.2% of total billed charges,1468.4,80,,,percent of total billed charges,80% of total billed charges,440.52,24,,,percent of total billed charges,24% of total billed charges ,440.52,24,,,percent of total billed charges,24% of total billed charges ,440.52,1468.4,
ACCESS AV DIAL GRAFT,2113302,CDM,360,RC,36901,HCPCS,Outpatient,,,4600,2300,,1235.56,26.86,,,percent of total billed charges,26.86% of total billed charges,3450,75,,,percent of total billed charges,75% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,1104,24,,,percent of total billed charges,24% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,3680,80,,,percent of total billed charges,80% of total billed charges ,1115.04,24.24,,,percent of total billed charges,24.24% of total billed charges ,2318.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,1126.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,1235.56,26.86,,,percent of total billed charges,26.86% of total billed charges,1104,24,,,percent of total billed charges,24% of total billed charges ,1435.2,31.2,,,percent of total billed charges,31.2% of total billed charges,3680,80,,,percent of total billed charges,80% of total billed charges,1104,24,,,percent of total billed charges,24% of total billed charges ,1104,24,,,percent of total billed charges,24% of total billed charges ,1104,3680,
AV GRAFT DIAL PROC,2113303,CDM,360,RC,36902,HCPCS,Outpatient,,,2259,1129.5,,606.77,26.86,,,percent of total billed charges,26.86% of total billed charges,1694.25,75,,,percent of total billed charges,75% of total billed charges ,1694.25,75,,,percent of total billed charges,75% of total billed charges ,542.16,24,,,percent of total billed charges,24% of total billed charges ,1694.25,75,,,percent of total billed charges,75% of total billed charges ,1694.25,75,,,percent of total billed charges,75% of total billed charges ,1807.2,80,,,percent of total billed charges,80% of total billed charges ,547.58,24.24,,,percent of total billed charges,24.24% of total billed charges ,1138.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,1694.25,75,,,percent of total billed charges,75% of total billed charges ,553,24.48,,,percent of total billed charges,24.48% of total billed charges ,606.77,26.86,,,percent of total billed charges,26.86% of total billed charges,542.16,24,,,percent of total billed charges,24% of total billed charges ,704.81,31.2,,,percent of total billed charges,31.2% of total billed charges,1807.2,80,,,percent of total billed charges,80% of total billed charges,542.16,24,,,percent of total billed charges,24% of total billed charges ,542.16,24,,,percent of total billed charges,24% of total billed charges ,542.16,1807.2,
CONTRAST INJ VEN DEV,2113304,CDM,360,RC,36598,HCPCS,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
MECH REMOVAL OBS MAT,2113305,CDM,360,RC,36595,HCPCS,Outpatient,,,753,376.5,,202.26,26.86,,,percent of total billed charges,26.86% of total billed charges,564.75,75,,,percent of total billed charges,75% of total billed charges ,564.75,75,,,percent of total billed charges,75% of total billed charges ,180.72,24,,,percent of total billed charges,24% of total billed charges ,564.75,75,,,percent of total billed charges,75% of total billed charges ,564.75,75,,,percent of total billed charges,75% of total billed charges ,602.4,80,,,percent of total billed charges,80% of total billed charges ,182.53,24.24,,,percent of total billed charges,24.24% of total billed charges ,379.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,564.75,75,,,percent of total billed charges,75% of total billed charges ,184.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,202.26,26.86,,,percent of total billed charges,26.86% of total billed charges,180.72,24,,,percent of total billed charges,24% of total billed charges ,234.94,31.2,,,percent of total billed charges,31.2% of total billed charges,602.4,80,,,percent of total billed charges,80% of total billed charges,180.72,24,,,percent of total billed charges,24% of total billed charges ,180.72,24,,,percent of total billed charges,24% of total billed charges ,180.72,602.4,
TRANSFORAMINAL EPIDURAL STEROID INJECTIO,2113306,CDM,361,RC,64483,HCPCS,Outpatient,,,6365.5,3182.75,,1709.77,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,1527.72,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,5092.4,80,,,percent of total billed charges,80% of total billed charges ,1543,24.24,,,percent of total billed charges,24.24% of total billed charges ,3208.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,4774.13,75,,,percent of total billed charges,75% of total billed charges ,1558.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,1709.77,26.86,,,percent of total billed charges,26.86% of total billed charges,1527.72,24,,,percent of total billed charges,24% of total billed charges ,1986.04,31.2,,,percent of total billed charges,31.2% of total billed charges,5092.4,80,,,percent of total billed charges,80% of total billed charges,1527.72,24,,,percent of total billed charges,24% of total billed charges ,1527.72,24,,,percent of total billed charges,24% of total billed charges ,1527.72,5092.4,
STENT PLACED ON ARTERY,2113307,CDM,360,RC,37236,HCPCS,Outpatient,,,17119.5,8559.75,,4598.3,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4108.68,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,13695.6,80,,,percent of total billed charges,80% of total billed charges ,4149.77,24.24,,,percent of total billed charges,24.24% of total billed charges ,8628.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,12839.63,75,,,percent of total billed charges,75% of total billed charges ,4190.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,4598.3,26.86,,,percent of total billed charges,26.86% of total billed charges,4108.68,24,,,percent of total billed charges,24% of total billed charges ,5341.28,31.2,,,percent of total billed charges,31.2% of total billed charges,13695.6,80,,,percent of total billed charges,80% of total billed charges,4108.68,24,,,percent of total billed charges,24% of total billed charges ,4108.68,24,,,percent of total billed charges,24% of total billed charges ,4108.68,13695.6,
ADDTL STENT IN ARTERY,2113308,CDM,360,RC,37237,HCPCS,Outpatient,,,10376,5188,,2786.99,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,2490.24,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,8300.8,80,,,percent of total billed charges,80% of total billed charges ,2515.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,5229.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,7782,75,,,percent of total billed charges,75% of total billed charges ,2540.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,2786.99,26.86,,,percent of total billed charges,26.86% of total billed charges,2490.24,24,,,percent of total billed charges,24% of total billed charges ,3237.31,31.2,,,percent of total billed charges,31.2% of total billed charges,8300.8,80,,,percent of total billed charges,80% of total billed charges,2490.24,24,,,percent of total billed charges,24% of total billed charges ,2490.24,24,,,percent of total billed charges,24% of total billed charges ,2490.24,8300.8,
VENOUS STENT,2113309,CDM,360,RC,37238,HCPCS,Outpatient,,,18507,9253.5,,4970.98,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4441.68,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,14805.6,80,,,percent of total billed charges,80% of total billed charges ,4486.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,9327.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,13880.25,75,,,percent of total billed charges,75% of total billed charges ,4530.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,4970.98,26.86,,,percent of total billed charges,26.86% of total billed charges,4441.68,24,,,percent of total billed charges,24% of total billed charges ,5774.18,31.2,,,percent of total billed charges,31.2% of total billed charges,14805.6,80,,,percent of total billed charges,80% of total billed charges,4441.68,24,,,percent of total billed charges,24% of total billed charges ,4441.68,24,,,percent of total billed charges,24% of total billed charges ,4394,14805.6,
ADDTL STENT IN VEIN,2113310,CDM,360,RC,37239,HCPCS,Outpatient,,,11826.5,5913.25,,3176.6,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,2838.36,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,9461.2,80,,,percent of total billed charges,80% of total billed charges ,2866.74,24.24,,,percent of total billed charges,24.24% of total billed charges ,5960.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,8869.88,75,,,percent of total billed charges,75% of total billed charges ,2895.13,24.48,,,percent of total billed charges,24.48% of total billed charges ,3176.6,26.86,,,percent of total billed charges,26.86% of total billed charges,2838.36,24,,,percent of total billed charges,24% of total billed charges ,3689.87,31.2,,,percent of total billed charges,31.2% of total billed charges,9461.2,80,,,percent of total billed charges,80% of total billed charges,2838.36,24,,,percent of total billed charges,24% of total billed charges ,2838.36,24,,,percent of total billed charges,24% of total billed charges ,2838.36,9461.2,
ACCESS AV FISTULOGRAM,2113311,CDM,360,RC,36901,HCPCS,Outpatient,,,4600,2300,,1235.56,26.86,,,percent of total billed charges,26.86% of total billed charges,3450,75,,,percent of total billed charges,75% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,1104,24,,,percent of total billed charges,24% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,3680,80,,,percent of total billed charges,80% of total billed charges ,1115.04,24.24,,,percent of total billed charges,24.24% of total billed charges ,2318.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,1126.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,1235.56,26.86,,,percent of total billed charges,26.86% of total billed charges,1104,24,,,percent of total billed charges,24% of total billed charges ,1435.2,31.2,,,percent of total billed charges,31.2% of total billed charges,3680,80,,,percent of total billed charges,80% of total billed charges,1104,24,,,percent of total billed charges,24% of total billed charges ,1104,24,,,percent of total billed charges,24% of total billed charges ,1104,3680,
ANGIOPLASTY NO STENT,2113312,CDM,360,RC,36902,HCPCS,Outpatient,,,21627,10813.5,,5809.01,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,5190.48,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,17301.6,80,,,percent of total billed charges,80% of total billed charges ,5242.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,10900.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,16220.25,75,,,percent of total billed charges,75% of total billed charges ,5294.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,5809.01,26.86,,,percent of total billed charges,26.86% of total billed charges,5190.48,24,,,percent of total billed charges,24% of total billed charges ,6747.62,31.2,,,percent of total billed charges,31.2% of total billed charges,17301.6,80,,,percent of total billed charges,80% of total billed charges,5190.48,24,,,percent of total billed charges,24% of total billed charges ,5190.48,24,,,percent of total billed charges,24% of total billed charges ,4394,17301.6,
ANGIOPLASTY W/ STENT,2113313,CDM,360,RC,36903,HCPCS,Outpatient,,,43711,21855.5,,11740.77,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,10490.64,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,34968.8,80,,,percent of total billed charges,80% of total billed charges ,10595.55,24.24,,,percent of total billed charges,24.24% of total billed charges ,22030.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,32783.25,75,,,percent of total billed charges,75% of total billed charges ,10700.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,11740.77,26.86,,,percent of total billed charges,26.86% of total billed charges,10490.64,24,,,percent of total billed charges,24% of total billed charges ,13637.83,31.2,,,percent of total billed charges,31.2% of total billed charges,34968.8,80,,,percent of total billed charges,80% of total billed charges,10490.64,24,,,percent of total billed charges,24% of total billed charges ,10490.64,24,,,percent of total billed charges,24% of total billed charges ,4394,34968.8,
THROMBECTOMY,2113314,CDM,360,RC,36904,HCPCS,Outpatient,,,25595.5,12797.75,,6874.95,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,6142.92,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,20476.4,80,,,percent of total billed charges,80% of total billed charges ,6204.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,12900.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,19196.63,75,,,percent of total billed charges,75% of total billed charges ,6265.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,6874.95,26.86,,,percent of total billed charges,26.86% of total billed charges,6142.92,24,,,percent of total billed charges,24% of total billed charges ,7985.8,31.2,,,percent of total billed charges,31.2% of total billed charges,20476.4,80,,,percent of total billed charges,80% of total billed charges,6142.92,24,,,percent of total billed charges,24% of total billed charges ,6142.92,24,,,percent of total billed charges,24% of total billed charges ,4394,20476.4,
THROMBECTOMY W/ BALLOON,2113315,CDM,360,RC,36905,HCPCS,Outpatient,,,51732,25866,,13895.22,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,12415.68,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,41385.6,80,,,percent of total billed charges,80% of total billed charges ,12539.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,26072.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,38799,75,,,percent of total billed charges,75% of total billed charges ,12663.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,13895.22,26.86,,,percent of total billed charges,26.86% of total billed charges,12415.68,24,,,percent of total billed charges,24% of total billed charges ,16140.38,31.2,,,percent of total billed charges,31.2% of total billed charges,41385.6,80,,,percent of total billed charges,80% of total billed charges,12415.68,24,,,percent of total billed charges,24% of total billed charges ,12415.68,24,,,percent of total billed charges,24% of total billed charges ,4394,41385.6,
THROMBECTOMY W/ STENT,2113316,CDM,360,RC,36906,HCPCS,Outpatient,,,78411,39205.5,,21061.19,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,18818.64,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,62728.8,80,,,percent of total billed charges,80% of total billed charges ,19006.83,24.24,,,percent of total billed charges,24.24% of total billed charges ,39519.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,58808.25,75,,,percent of total billed charges,75% of total billed charges ,19195.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,21061.19,26.86,,,percent of total billed charges,26.86% of total billed charges,18818.64,24,,,percent of total billed charges,24% of total billed charges ,24464.23,31.2,,,percent of total billed charges,31.2% of total billed charges,62728.8,80,,,percent of total billed charges,80% of total billed charges,18818.64,24,,,percent of total billed charges,24% of total billed charges ,18818.64,24,,,percent of total billed charges,24% of total billed charges ,4394,62728.8,
BALLOON ANGIOPLASTY,2113317,CDM,360,RC,36907,HCPCS,Outpatient,,,4600,2300,,1235.56,26.86,,,percent of total billed charges,26.86% of total billed charges,3450,75,,,percent of total billed charges,75% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,1104,24,,,percent of total billed charges,24% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,3680,80,,,percent of total billed charges,80% of total billed charges ,1115.04,24.24,,,percent of total billed charges,24.24% of total billed charges ,2318.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,1126.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,1235.56,26.86,,,percent of total billed charges,26.86% of total billed charges,1104,24,,,percent of total billed charges,24% of total billed charges ,1435.2,31.2,,,percent of total billed charges,31.2% of total billed charges,3680,80,,,percent of total billed charges,80% of total billed charges,1104,24,,,percent of total billed charges,24% of total billed charges ,1104,24,,,percent of total billed charges,24% of total billed charges ,1104,3680,
TRANSCATH STENT PLACEMENT,2113318,CDM,360,RC,36908,HCPCS,Outpatient,,,4600,2300,,1235.56,26.86,,,percent of total billed charges,26.86% of total billed charges,3450,75,,,percent of total billed charges,75% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,1104,24,,,percent of total billed charges,24% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,3680,80,,,percent of total billed charges,80% of total billed charges ,1115.04,24.24,,,percent of total billed charges,24.24% of total billed charges ,2318.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,1126.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,1235.56,26.86,,,percent of total billed charges,26.86% of total billed charges,1104,24,,,percent of total billed charges,24% of total billed charges ,1435.2,31.2,,,percent of total billed charges,31.2% of total billed charges,3680,80,,,percent of total billed charges,80% of total billed charges,1104,24,,,percent of total billed charges,24% of total billed charges ,1104,24,,,percent of total billed charges,24% of total billed charges ,1104,3680,
VEIN EMBOLIZATION,2113319,CDM,360,RC,36909,HCPCS,Outpatient,,,4600,2300,,1235.56,26.86,,,percent of total billed charges,26.86% of total billed charges,3450,75,,,percent of total billed charges,75% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,1104,24,,,percent of total billed charges,24% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,3680,80,,,percent of total billed charges,80% of total billed charges ,1115.04,24.24,,,percent of total billed charges,24.24% of total billed charges ,2318.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,3450,75,,,percent of total billed charges,75% of total billed charges ,1126.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,1235.56,26.86,,,percent of total billed charges,26.86% of total billed charges,1104,24,,,percent of total billed charges,24% of total billed charges ,1435.2,31.2,,,percent of total billed charges,31.2% of total billed charges,3680,80,,,percent of total billed charges,80% of total billed charges,1104,24,,,percent of total billed charges,24% of total billed charges ,1104,24,,,percent of total billed charges,24% of total billed charges ,1104,3680,
VENOGRAPHY,2113320,CDM,360,RC,75827,HCPCS,Outpatient,,,3628.5,1814.25,,974.62,26.86,,,percent of total billed charges,26.86% of total billed charges,2721.38,75,,,percent of total billed charges,75% of total billed charges ,2721.38,75,,,percent of total billed charges,75% of total billed charges ,870.84,24,,,percent of total billed charges,24% of total billed charges ,2721.38,75,,,percent of total billed charges,75% of total billed charges ,2721.38,75,,,percent of total billed charges,75% of total billed charges ,2902.8,80,,,percent of total billed charges,80% of total billed charges ,879.55,24.24,,,percent of total billed charges,24.24% of total billed charges ,1828.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,2721.38,75,,,percent of total billed charges,75% of total billed charges ,888.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,974.62,26.86,,,percent of total billed charges,26.86% of total billed charges,870.84,24,,,percent of total billed charges,24% of total billed charges ,1132.09,31.2,,,percent of total billed charges,31.2% of total billed charges,2902.8,80,,,percent of total billed charges,80% of total billed charges,870.84,24,,,percent of total billed charges,24% of total billed charges ,870.84,24,,,percent of total billed charges,24% of total billed charges ,870.84,2902.8,
FLUOROGUIDE FOR VEIN DEVICE,2113321,CDM,360,RC,77001,HCPCS,Outpatient,,,681,340.5,,182.92,26.86,,,percent of total billed charges,26.86% of total billed charges,510.75,75,,,percent of total billed charges,75% of total billed charges ,510.75,75,,,percent of total billed charges,75% of total billed charges ,163.44,24,,,percent of total billed charges,24% of total billed charges ,510.75,75,,,percent of total billed charges,75% of total billed charges ,510.75,75,,,percent of total billed charges,75% of total billed charges ,544.8,80,,,percent of total billed charges,80% of total billed charges ,165.07,24.24,,,percent of total billed charges,24.24% of total billed charges ,343.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,510.75,75,,,percent of total billed charges,75% of total billed charges ,166.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,182.92,26.86,,,percent of total billed charges,26.86% of total billed charges,163.44,24,,,percent of total billed charges,24% of total billed charges ,212.47,31.2,,,percent of total billed charges,31.2% of total billed charges,544.8,80,,,percent of total billed charges,80% of total billed charges,163.44,24,,,percent of total billed charges,24% of total billed charges ,163.44,24,,,percent of total billed charges,24% of total billed charges ,163.44,544.8,
REM TUNNELED CVAD W PORT/PUMP,2113322,CDM,360,RC,36590,HCPCS,Outpatient,,,3183.5,1591.75,,855.09,26.86,,,percent of total billed charges,26.86% of total billed charges,2387.63,75,,,percent of total billed charges,75% of total billed charges ,2387.63,75,,,percent of total billed charges,75% of total billed charges ,764.04,24,,,percent of total billed charges,24% of total billed charges ,2387.63,75,,,percent of total billed charges,75% of total billed charges ,2387.63,75,,,percent of total billed charges,75% of total billed charges ,2546.8,80,,,percent of total billed charges,80% of total billed charges ,771.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,1604.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2387.63,75,,,percent of total billed charges,75% of total billed charges ,779.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,855.09,26.86,,,percent of total billed charges,26.86% of total billed charges,764.04,24,,,percent of total billed charges,24% of total billed charges ,993.25,31.2,,,percent of total billed charges,31.2% of total billed charges,2546.8,80,,,percent of total billed charges,80% of total billed charges,764.04,24,,,percent of total billed charges,24% of total billed charges ,764.04,24,,,percent of total billed charges,24% of total billed charges ,764.04,2546.8,
IRIDOTOMY,2115000,CDM,360,RC,66761,HCPCS,Outpatient,,,753,376.5,,202.26,26.86,,,percent of total billed charges,26.86% of total billed charges,564.75,75,,,percent of total billed charges,75% of total billed charges ,564.75,75,,,percent of total billed charges,75% of total billed charges ,180.72,24,,,percent of total billed charges,24% of total billed charges ,564.75,75,,,percent of total billed charges,75% of total billed charges ,564.75,75,,,percent of total billed charges,75% of total billed charges ,602.4,80,,,percent of total billed charges,80% of total billed charges ,182.53,24.24,,,percent of total billed charges,24.24% of total billed charges ,379.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,564.75,75,,,percent of total billed charges,75% of total billed charges ,184.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,202.26,26.86,,,percent of total billed charges,26.86% of total billed charges,180.72,24,,,percent of total billed charges,24% of total billed charges ,234.94,31.2,,,percent of total billed charges,31.2% of total billed charges,602.4,80,,,percent of total billed charges,80% of total billed charges,180.72,24,,,percent of total billed charges,24% of total billed charges ,180.72,24,,,percent of total billed charges,24% of total billed charges ,180.72,602.4,
PHOTOCOAG LASER,2115001,CDM,360,RC,67228,HCPCS,Outpatient,,,1600.5,800.25,,429.89,26.86,,,percent of total billed charges,26.86% of total billed charges,1200.38,75,,,percent of total billed charges,75% of total billed charges ,1200.38,75,,,percent of total billed charges,75% of total billed charges ,384.12,24,,,percent of total billed charges,24% of total billed charges ,1200.38,75,,,percent of total billed charges,75% of total billed charges ,1200.38,75,,,percent of total billed charges,75% of total billed charges ,1280.4,80,,,percent of total billed charges,80% of total billed charges ,387.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,806.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,1200.38,75,,,percent of total billed charges,75% of total billed charges ,391.8,24.48,,,percent of total billed charges,24.48% of total billed charges ,429.89,26.86,,,percent of total billed charges,26.86% of total billed charges,384.12,24,,,percent of total billed charges,24% of total billed charges ,499.36,31.2,,,percent of total billed charges,31.2% of total billed charges,1280.4,80,,,percent of total billed charges,80% of total billed charges,384.12,24,,,percent of total billed charges,24% of total billed charges ,384.12,24,,,percent of total billed charges,24% of total billed charges ,384.12,1280.4,
PHOTOCOAG FOCAL/GRID,2115002,CDM,360,RC,67210,HCPCS,Outpatient,,,1224.5,612.25,,328.9,26.86,,,percent of total billed charges,26.86% of total billed charges,918.38,75,,,percent of total billed charges,75% of total billed charges ,918.38,75,,,percent of total billed charges,75% of total billed charges ,293.88,24,,,percent of total billed charges,24% of total billed charges ,918.38,75,,,percent of total billed charges,75% of total billed charges ,918.38,75,,,percent of total billed charges,75% of total billed charges ,979.6,80,,,percent of total billed charges,80% of total billed charges ,296.82,24.24,,,percent of total billed charges,24.24% of total billed charges ,617.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,918.38,75,,,percent of total billed charges,75% of total billed charges ,299.76,24.48,,,percent of total billed charges,24.48% of total billed charges ,328.9,26.86,,,percent of total billed charges,26.86% of total billed charges,293.88,24,,,percent of total billed charges,24% of total billed charges ,382.04,31.2,,,percent of total billed charges,31.2% of total billed charges,979.6,80,,,percent of total billed charges,80% of total billed charges,293.88,24,,,percent of total billed charges,24% of total billed charges ,293.88,24,,,percent of total billed charges,24% of total billed charges ,293.88,979.6,
PROPHYLAXIS OF RD,2115003,CDM,360,RC,67145,HCPCS,Outpatient,,,847.5,423.75,,227.64,26.86,,,percent of total billed charges,26.86% of total billed charges,635.63,75,,,percent of total billed charges,75% of total billed charges ,635.63,75,,,percent of total billed charges,75% of total billed charges ,203.4,24,,,percent of total billed charges,24% of total billed charges ,635.63,75,,,percent of total billed charges,75% of total billed charges ,635.63,75,,,percent of total billed charges,75% of total billed charges ,678,80,,,percent of total billed charges,80% of total billed charges ,205.43,24.24,,,percent of total billed charges,24.24% of total billed charges ,427.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,635.63,75,,,percent of total billed charges,75% of total billed charges ,207.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,227.64,26.86,,,percent of total billed charges,26.86% of total billed charges,203.4,24,,,percent of total billed charges,24% of total billed charges ,264.42,31.2,,,percent of total billed charges,31.2% of total billed charges,678,80,,,percent of total billed charges,80% of total billed charges,203.4,24,,,percent of total billed charges,24% of total billed charges ,203.4,24,,,percent of total billed charges,24% of total billed charges ,203.4,678,
TRABECULOPLASTY ALT,2115004,CDM,360,RC,65855,HCPCS,Outpatient,,,660,330,,177.28,26.86,,,percent of total billed charges,26.86% of total billed charges,495,75,,,percent of total billed charges,75% of total billed charges ,495,75,,,percent of total billed charges,75% of total billed charges ,158.4,24,,,percent of total billed charges,24% of total billed charges ,495,75,,,percent of total billed charges,75% of total billed charges ,495,75,,,percent of total billed charges,75% of total billed charges ,528,80,,,percent of total billed charges,80% of total billed charges ,159.98,24.24,,,percent of total billed charges,24.24% of total billed charges ,332.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,495,75,,,percent of total billed charges,75% of total billed charges ,161.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,177.28,26.86,,,percent of total billed charges,26.86% of total billed charges,158.4,24,,,percent of total billed charges,24% of total billed charges ,205.92,31.2,,,percent of total billed charges,31.2% of total billed charges,528,80,,,percent of total billed charges,80% of total billed charges,158.4,24,,,percent of total billed charges,24% of total billed charges ,158.4,24,,,percent of total billed charges,24% of total billed charges ,158.4,528,
PHOTOCOAG REPAIR,2115005,CDM,360,RC,67105,HCPCS,Outpatient,,,1036,518,,278.27,26.86,,,percent of total billed charges,26.86% of total billed charges,777,75,,,percent of total billed charges,75% of total billed charges ,777,75,,,percent of total billed charges,75% of total billed charges ,248.64,24,,,percent of total billed charges,24% of total billed charges ,777,75,,,percent of total billed charges,75% of total billed charges ,777,75,,,percent of total billed charges,75% of total billed charges ,828.8,80,,,percent of total billed charges,80% of total billed charges ,251.13,24.24,,,percent of total billed charges,24.24% of total billed charges ,522.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,777,75,,,percent of total billed charges,75% of total billed charges ,253.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,278.27,26.86,,,percent of total billed charges,26.86% of total billed charges,248.64,24,,,percent of total billed charges,24% of total billed charges ,323.23,31.2,,,percent of total billed charges,31.2% of total billed charges,828.8,80,,,percent of total billed charges,80% of total billed charges,248.64,24,,,percent of total billed charges,24% of total billed charges ,248.64,24,,,percent of total billed charges,24% of total billed charges ,248.64,828.8,
OR-ERCP,2115010,CDM,360,RC,,,Outpatient,,,1765.5,882.75,,474.21,26.86,,,percent of total billed charges,26.86% of total billed charges,1324.13,75,,,percent of total billed charges,75% of total billed charges ,1324.13,75,,,percent of total billed charges,75% of total billed charges ,423.72,24,,,percent of total billed charges,24% of total billed charges ,1324.13,75,,,percent of total billed charges,75% of total billed charges ,1324.13,75,,,percent of total billed charges,75% of total billed charges ,1412.4,80,,,percent of total billed charges,80% of total billed charges ,427.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,889.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,1324.13,75,,,percent of total billed charges,75% of total billed charges ,432.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,474.21,26.86,,,percent of total billed charges,26.86% of total billed charges,423.72,24,,,percent of total billed charges,24% of total billed charges ,550.84,31.2,,,percent of total billed charges,31.2% of total billed charges,1412.4,80,,,percent of total billed charges,80% of total billed charges,423.72,24,,,percent of total billed charges,24% of total billed charges ,423.72,24,,,percent of total billed charges,24% of total billed charges ,423.72,1412.4,
OR-EUS,2115020,CDM,360,RC,,,Outpatient,,,1765.5,882.75,,474.21,26.86,,,percent of total billed charges,26.86% of total billed charges,1324.13,75,,,percent of total billed charges,75% of total billed charges ,1324.13,75,,,percent of total billed charges,75% of total billed charges ,423.72,24,,,percent of total billed charges,24% of total billed charges ,1324.13,75,,,percent of total billed charges,75% of total billed charges ,1324.13,75,,,percent of total billed charges,75% of total billed charges ,1412.4,80,,,percent of total billed charges,80% of total billed charges ,427.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,889.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,1324.13,75,,,percent of total billed charges,75% of total billed charges ,432.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,474.21,26.86,,,percent of total billed charges,26.86% of total billed charges,423.72,24,,,percent of total billed charges,24% of total billed charges ,550.84,31.2,,,percent of total billed charges,31.2% of total billed charges,1412.4,80,,,percent of total billed charges,80% of total billed charges,423.72,24,,,percent of total billed charges,24% of total billed charges ,423.72,24,,,percent of total billed charges,24% of total billed charges ,423.72,1412.4,
OR-COLONOSCOPY,2115030,CDM,360,RC,,,Outpatient,,,1176.5,588.25,,316.01,26.86,,,percent of total billed charges,26.86% of total billed charges,882.38,75,,,percent of total billed charges,75% of total billed charges ,882.38,75,,,percent of total billed charges,75% of total billed charges ,282.36,24,,,percent of total billed charges,24% of total billed charges ,882.38,75,,,percent of total billed charges,75% of total billed charges ,882.38,75,,,percent of total billed charges,75% of total billed charges ,941.2,80,,,percent of total billed charges,80% of total billed charges ,285.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,592.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,882.38,75,,,percent of total billed charges,75% of total billed charges ,288.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,316.01,26.86,,,percent of total billed charges,26.86% of total billed charges,282.36,24,,,percent of total billed charges,24% of total billed charges ,367.07,31.2,,,percent of total billed charges,31.2% of total billed charges,941.2,80,,,percent of total billed charges,80% of total billed charges,282.36,24,,,percent of total billed charges,24% of total billed charges ,282.36,24,,,percent of total billed charges,24% of total billed charges ,282.36,941.2,
OR-BRONCHOSCOPE,2115040,CDM,360,RC,,,Outpatient,,,941.5,470.75,,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,753.2,80,,,percent of total billed charges,80% of total billed charges ,228.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,474.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,230.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,293.75,31.2,,,percent of total billed charges,31.2% of total billed charges,753.2,80,,,percent of total billed charges,80% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,753.2,
OR-FLEX SIG,2115050,CDM,360,RC,,,Outpatient,,,1176.5,588.25,,316.01,26.86,,,percent of total billed charges,26.86% of total billed charges,882.38,75,,,percent of total billed charges,75% of total billed charges ,882.38,75,,,percent of total billed charges,75% of total billed charges ,282.36,24,,,percent of total billed charges,24% of total billed charges ,882.38,75,,,percent of total billed charges,75% of total billed charges ,882.38,75,,,percent of total billed charges,75% of total billed charges ,941.2,80,,,percent of total billed charges,80% of total billed charges ,285.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,592.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,882.38,75,,,percent of total billed charges,75% of total billed charges ,288.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,316.01,26.86,,,percent of total billed charges,26.86% of total billed charges,282.36,24,,,percent of total billed charges,24% of total billed charges ,367.07,31.2,,,percent of total billed charges,31.2% of total billed charges,941.2,80,,,percent of total billed charges,80% of total billed charges,282.36,24,,,percent of total billed charges,24% of total billed charges ,282.36,24,,,percent of total billed charges,24% of total billed charges ,282.36,941.2,
OR-EGD,2115060,CDM,360,RC,,,Outpatient,,,1176.5,588.25,,316.01,26.86,,,percent of total billed charges,26.86% of total billed charges,882.38,75,,,percent of total billed charges,75% of total billed charges ,882.38,75,,,percent of total billed charges,75% of total billed charges ,282.36,24,,,percent of total billed charges,24% of total billed charges ,882.38,75,,,percent of total billed charges,75% of total billed charges ,882.38,75,,,percent of total billed charges,75% of total billed charges ,941.2,80,,,percent of total billed charges,80% of total billed charges ,285.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,592.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,882.38,75,,,percent of total billed charges,75% of total billed charges ,288.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,316.01,26.86,,,percent of total billed charges,26.86% of total billed charges,282.36,24,,,percent of total billed charges,24% of total billed charges ,367.07,31.2,,,percent of total billed charges,31.2% of total billed charges,941.2,80,,,percent of total billed charges,80% of total billed charges,282.36,24,,,percent of total billed charges,24% of total billed charges ,282.36,24,,,percent of total billed charges,24% of total billed charges ,282.36,941.2,
TRANSCATH INTR STENT,2120043,CDM,360,RC,37236,HCPCS,Outpatient,,,830,415,,222.94,26.86,,,percent of total billed charges,26.86% of total billed charges,622.5,75,,,percent of total billed charges,75% of total billed charges ,622.5,75,,,percent of total billed charges,75% of total billed charges ,199.2,24,,,percent of total billed charges,24% of total billed charges ,622.5,75,,,percent of total billed charges,75% of total billed charges ,622.5,75,,,percent of total billed charges,75% of total billed charges ,664,80,,,percent of total billed charges,80% of total billed charges ,201.19,24.24,,,percent of total billed charges,24.24% of total billed charges ,418.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,622.5,75,,,percent of total billed charges,75% of total billed charges ,203.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,222.94,26.86,,,percent of total billed charges,26.86% of total billed charges,199.2,24,,,percent of total billed charges,24% of total billed charges ,258.96,31.2,,,percent of total billed charges,31.2% of total billed charges,664,80,,,percent of total billed charges,80% of total billed charges,199.2,24,,,percent of total billed charges,24% of total billed charges ,199.2,24,,,percent of total billed charges,24% of total billed charges ,199.2,664,
PT ANGIOPLAST VENOUS,2120046,CDM,360,RC,37248,HCPCS,Outpatient,,,3404,1702,,914.31,26.86,,,percent of total billed charges,26.86% of total billed charges,2553,75,,,percent of total billed charges,75% of total billed charges ,2553,75,,,percent of total billed charges,75% of total billed charges ,816.96,24,,,percent of total billed charges,24% of total billed charges ,2553,75,,,percent of total billed charges,75% of total billed charges ,2553,75,,,percent of total billed charges,75% of total billed charges ,2723.2,80,,,percent of total billed charges,80% of total billed charges ,825.13,24.24,,,percent of total billed charges,24.24% of total billed charges ,1715.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,2553,75,,,percent of total billed charges,75% of total billed charges ,833.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,914.31,26.86,,,percent of total billed charges,26.86% of total billed charges,816.96,24,,,percent of total billed charges,24% of total billed charges ,1062.05,31.2,,,percent of total billed charges,31.2% of total billed charges,2723.2,80,,,percent of total billed charges,80% of total billed charges,816.96,24,,,percent of total billed charges,24% of total billed charges ,816.96,24,,,percent of total billed charges,24% of total billed charges ,816.96,2723.2,
INJECT-CONT INTR-ART,2120047,CDM,360,RC,,,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
INJECT-CONT INTR VEN,2120048,CDM,360,RC,,,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
OVESCO CLIP BLUNT TEETH 10.5-12mm,2120060,CDM,272,RC,,,Outpatient,,,1470,735,,394.84,26.86,,,percent of total billed charges,26.86% of total billed charges,1102.5,75,,,percent of total billed charges,75% of total billed charges ,1102.5,75,,,percent of total billed charges,75% of total billed charges ,352.8,24,,,percent of total billed charges,24% of total billed charges ,1102.5,75,,,percent of total billed charges,75% of total billed charges ,1102.5,75,,,percent of total billed charges,75% of total billed charges ,1176,80,,,percent of total billed charges,80% of total billed charges ,356.33,24.24,,,percent of total billed charges,24.24% of total billed charges ,740.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,1102.5,75,,,percent of total billed charges,75% of total billed charges ,359.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,394.84,26.86,,,percent of total billed charges,26.86% of total billed charges,352.8,24,,,percent of total billed charges,24% of total billed charges ,458.64,31.2,,,percent of total billed charges,31.2% of total billed charges,1176,80,,,percent of total billed charges,80% of total billed charges,352.8,24,,,percent of total billed charges,24% of total billed charges ,352.8,24,,,percent of total billed charges,24% of total billed charges ,352.8,1176,
SURGIMESH 15CM CIRCL,2120063,CDM,278,RC,C1781,HCPCS,Outpatient,,,5773,2886.5,,1550.63,26.86,,,percent of total billed charges,26.86% of total billed charges,4329.75,75,,,percent of total billed charges,75% of total billed charges ,4329.75,75,,,percent of total billed charges,75% of total billed charges ,1385.52,24,,,percent of total billed charges,24% of total billed charges ,4329.75,75,,,percent of total billed charges,75% of total billed charges ,4329.75,75,,,percent of total billed charges,75% of total billed charges ,4618.4,80,,,percent of total billed charges,80% of total billed charges ,1399.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,2909.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,4329.75,75,,,percent of total billed charges,75% of total billed charges ,1413.23,24.48,,,percent of total billed charges,24.48% of total billed charges ,1550.63,26.86,,,percent of total billed charges,26.86% of total billed charges,1385.52,24,,,percent of total billed charges,24% of total billed charges ,1801.18,31.2,,,percent of total billed charges,31.2% of total billed charges,4618.4,80,,,percent of total billed charges,80% of total billed charges,1385.52,24,,,percent of total billed charges,24% of total billed charges ,1385.52,24,,,percent of total billed charges,24% of total billed charges ,1385.52,4618.4,
SURGIMESH 22X26 ECLI,2120064,CDM,278,RC,C1781,HCPCS,Outpatient,,,9912.5,4956.25,,2662.5,26.86,,,percent of total billed charges,26.86% of total billed charges,7434.38,75,,,percent of total billed charges,75% of total billed charges ,7434.38,75,,,percent of total billed charges,75% of total billed charges ,2379,24,,,percent of total billed charges,24% of total billed charges ,7434.38,75,,,percent of total billed charges,75% of total billed charges ,7434.38,75,,,percent of total billed charges,75% of total billed charges ,7930,80,,,percent of total billed charges,80% of total billed charges ,2402.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,4995.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,7434.38,75,,,percent of total billed charges,75% of total billed charges ,2426.58,24.48,,,percent of total billed charges,24.48% of total billed charges ,2662.5,26.86,,,percent of total billed charges,26.86% of total billed charges,2379,24,,,percent of total billed charges,24% of total billed charges ,3092.7,31.2,,,percent of total billed charges,31.2% of total billed charges,7930,80,,,percent of total billed charges,80% of total billed charges,2379,24,,,percent of total billed charges,24% of total billed charges ,2379,24,,,percent of total billed charges,24% of total billed charges ,2379,7930,
SURGIMESH 26X36,2120065,CDM,278,RC,C1781,HCPCS,Outpatient,,,11324,5662,,3041.63,26.86,,,percent of total billed charges,26.86% of total billed charges,8493,75,,,percent of total billed charges,75% of total billed charges ,8493,75,,,percent of total billed charges,75% of total billed charges ,2717.76,24,,,percent of total billed charges,24% of total billed charges ,8493,75,,,percent of total billed charges,75% of total billed charges ,8493,75,,,percent of total billed charges,75% of total billed charges ,9059.2,80,,,percent of total billed charges,80% of total billed charges ,2744.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,5707.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,8493,75,,,percent of total billed charges,75% of total billed charges ,2772.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,3041.63,26.86,,,percent of total billed charges,26.86% of total billed charges,2717.76,24,,,percent of total billed charges,24% of total billed charges ,3533.09,31.2,,,percent of total billed charges,31.2% of total billed charges,9059.2,80,,,percent of total billed charges,80% of total billed charges,2717.76,24,,,percent of total billed charges,24% of total billed charges ,2717.76,24,,,percent of total billed charges,24% of total billed charges ,2717.76,9059.2,
OR LEVEL 1 OR INITAL 30,2120066,CDM,360,RC,,,Outpatient,,,2824.5,1412.25,,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,2259.6,80,,,percent of total billed charges,80% of total billed charges ,684.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,1423.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,2118.38,75,,,percent of total billed charges,75% of total billed charges ,691.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,758.66,26.86,,,percent of total billed charges,26.86% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,881.24,31.2,,,percent of total billed charges,31.2% of total billed charges,2259.6,80,,,percent of total billed charges,80% of total billed charges,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,24,,,percent of total billed charges,24% of total billed charges ,677.88,2259.6,
OR LEVEL 1 OR ADDL MIN,2120067,CDM,360,RC,,,Outpatient,,,23.5,11.75,,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,18.8,80,,,percent of total billed charges,80% of total billed charges ,5.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,7.33,31.2,,,percent of total billed charges,31.2% of total billed charges,18.8,80,,,percent of total billed charges,80% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,18.8,
OR LEVEL 1 MULTIPLE PRO,2120068,CDM,360,RC,,,Outpatient,,,947.5,473.75,,254.5,26.86,,,percent of total billed charges,26.86% of total billed charges,710.63,75,,,percent of total billed charges,75% of total billed charges ,710.63,75,,,percent of total billed charges,75% of total billed charges ,227.4,24,,,percent of total billed charges,24% of total billed charges ,710.63,75,,,percent of total billed charges,75% of total billed charges ,710.63,75,,,percent of total billed charges,75% of total billed charges ,758,80,,,percent of total billed charges,80% of total billed charges ,229.67,24.24,,,percent of total billed charges,24.24% of total billed charges ,477.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,710.63,75,,,percent of total billed charges,75% of total billed charges ,231.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,254.5,26.86,,,percent of total billed charges,26.86% of total billed charges,227.4,24,,,percent of total billed charges,24% of total billed charges ,295.62,31.2,,,percent of total billed charges,31.2% of total billed charges,758,80,,,percent of total billed charges,80% of total billed charges,227.4,24,,,percent of total billed charges,24% of total billed charges ,227.4,24,,,percent of total billed charges,24% of total billed charges ,227.4,758,
OR LEVEL 2 OR INIT 30MI,2120069,CDM,360,RC,,,Outpatient,,,2507,1253.5,,673.38,26.86,,,percent of total billed charges,26.86% of total billed charges,1880.25,75,,,percent of total billed charges,75% of total billed charges ,1880.25,75,,,percent of total billed charges,75% of total billed charges ,601.68,24,,,percent of total billed charges,24% of total billed charges ,1880.25,75,,,percent of total billed charges,75% of total billed charges ,1880.25,75,,,percent of total billed charges,75% of total billed charges ,2005.6,80,,,percent of total billed charges,80% of total billed charges ,607.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,1263.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,1880.25,75,,,percent of total billed charges,75% of total billed charges ,613.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,673.38,26.86,,,percent of total billed charges,26.86% of total billed charges,601.68,24,,,percent of total billed charges,24% of total billed charges ,782.18,31.2,,,percent of total billed charges,31.2% of total billed charges,2005.6,80,,,percent of total billed charges,80% of total billed charges,601.68,24,,,percent of total billed charges,24% of total billed charges ,601.68,24,,,percent of total billed charges,24% of total billed charges ,601.68,2005.6,
OR LEVEL 2 OR EACH ADD,2120070,CDM,360,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
OR LEVEL 2 MULTIPLE PRO,2120071,CDM,360,RC,,,Outpatient,,,836.5,418.25,,224.68,26.86,,,percent of total billed charges,26.86% of total billed charges,627.38,75,,,percent of total billed charges,75% of total billed charges ,627.38,75,,,percent of total billed charges,75% of total billed charges ,200.76,24,,,percent of total billed charges,24% of total billed charges ,627.38,75,,,percent of total billed charges,75% of total billed charges ,627.38,75,,,percent of total billed charges,75% of total billed charges ,669.2,80,,,percent of total billed charges,80% of total billed charges ,202.77,24.24,,,percent of total billed charges,24.24% of total billed charges ,421.6,50.4,,,percent of total billed charges,50.4% of total billed charges ,627.38,75,,,percent of total billed charges,75% of total billed charges ,204.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,224.68,26.86,,,percent of total billed charges,26.86% of total billed charges,200.76,24,,,percent of total billed charges,24% of total billed charges ,260.99,31.2,,,percent of total billed charges,31.2% of total billed charges,669.2,80,,,percent of total billed charges,80% of total billed charges,200.76,24,,,percent of total billed charges,24% of total billed charges ,200.76,24,,,percent of total billed charges,24% of total billed charges ,200.76,669.2,
OR LEVEL 3 OR INIT 30MI,2120072,CDM,360,RC,,,Outpatient,,,2172.5,1086.25,,583.53,26.86,,,percent of total billed charges,26.86% of total billed charges,1629.38,75,,,percent of total billed charges,75% of total billed charges ,1629.38,75,,,percent of total billed charges,75% of total billed charges ,521.4,24,,,percent of total billed charges,24% of total billed charges ,1629.38,75,,,percent of total billed charges,75% of total billed charges ,1629.38,75,,,percent of total billed charges,75% of total billed charges ,1738,80,,,percent of total billed charges,80% of total billed charges ,526.61,24.24,,,percent of total billed charges,24.24% of total billed charges ,1094.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,1629.38,75,,,percent of total billed charges,75% of total billed charges ,531.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,583.53,26.86,,,percent of total billed charges,26.86% of total billed charges,521.4,24,,,percent of total billed charges,24% of total billed charges ,677.82,31.2,,,percent of total billed charges,31.2% of total billed charges,1738,80,,,percent of total billed charges,80% of total billed charges,521.4,24,,,percent of total billed charges,24% of total billed charges ,521.4,24,,,percent of total billed charges,24% of total billed charges ,521.4,1738,
OR LEVEL 3 OR EACH ADDL,2120073,CDM,360,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
OR LEVEL 3 MULTI PROCED,2120074,CDM,360,RC,,,Outpatient,,,724,362,,194.47,26.86,,,percent of total billed charges,26.86% of total billed charges,543,75,,,percent of total billed charges,75% of total billed charges ,543,75,,,percent of total billed charges,75% of total billed charges ,173.76,24,,,percent of total billed charges,24% of total billed charges ,543,75,,,percent of total billed charges,75% of total billed charges ,543,75,,,percent of total billed charges,75% of total billed charges ,579.2,80,,,percent of total billed charges,80% of total billed charges ,175.5,24.24,,,percent of total billed charges,24.24% of total billed charges ,364.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,543,75,,,percent of total billed charges,75% of total billed charges ,177.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,194.47,26.86,,,percent of total billed charges,26.86% of total billed charges,173.76,24,,,percent of total billed charges,24% of total billed charges ,225.89,31.2,,,percent of total billed charges,31.2% of total billed charges,579.2,80,,,percent of total billed charges,80% of total billed charges,173.76,24,,,percent of total billed charges,24% of total billed charges ,173.76,24,,,percent of total billed charges,24% of total billed charges ,173.76,579.2,
OR LEVEL 4 OR INIT 30MI,2120075,CDM,360,RC,,,Outpatient,,,1838.5,919.25,,493.82,26.86,,,percent of total billed charges,26.86% of total billed charges,1378.88,75,,,percent of total billed charges,75% of total billed charges ,1378.88,75,,,percent of total billed charges,75% of total billed charges ,441.24,24,,,percent of total billed charges,24% of total billed charges ,1378.88,75,,,percent of total billed charges,75% of total billed charges ,1378.88,75,,,percent of total billed charges,75% of total billed charges ,1470.8,80,,,percent of total billed charges,80% of total billed charges ,445.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,926.6,50.4,,,percent of total billed charges,50.4% of total billed charges ,1378.88,75,,,percent of total billed charges,75% of total billed charges ,450.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,493.82,26.86,,,percent of total billed charges,26.86% of total billed charges,441.24,24,,,percent of total billed charges,24% of total billed charges ,573.61,31.2,,,percent of total billed charges,31.2% of total billed charges,1470.8,80,,,percent of total billed charges,80% of total billed charges,441.24,24,,,percent of total billed charges,24% of total billed charges ,441.24,24,,,percent of total billed charges,24% of total billed charges ,441.24,1470.8,
OR LEVEL 4 OR EACH ADDL,2120076,CDM,360,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
OR LEVEL 4 MULTI PROCED,2120077,CDM,360,RC,,,Outpatient,,,557,278.5,,149.61,26.86,,,percent of total billed charges,26.86% of total billed charges,417.75,75,,,percent of total billed charges,75% of total billed charges ,417.75,75,,,percent of total billed charges,75% of total billed charges ,133.68,24,,,percent of total billed charges,24% of total billed charges ,417.75,75,,,percent of total billed charges,75% of total billed charges ,417.75,75,,,percent of total billed charges,75% of total billed charges ,445.6,80,,,percent of total billed charges,80% of total billed charges ,135.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,280.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,417.75,75,,,percent of total billed charges,75% of total billed charges ,136.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,149.61,26.86,,,percent of total billed charges,26.86% of total billed charges,133.68,24,,,percent of total billed charges,24% of total billed charges ,173.78,31.2,,,percent of total billed charges,31.2% of total billed charges,445.6,80,,,percent of total billed charges,80% of total billed charges,133.68,24,,,percent of total billed charges,24% of total billed charges ,133.68,24,,,percent of total billed charges,24% of total billed charges ,133.68,445.6,
OR LEVEL 5 OR INIT 30MI,2120078,CDM,360,RC,,,Outpatient,,,1520.5,760.25,,408.41,26.86,,,percent of total billed charges,26.86% of total billed charges,1140.38,75,,,percent of total billed charges,75% of total billed charges ,1140.38,75,,,percent of total billed charges,75% of total billed charges ,364.92,24,,,percent of total billed charges,24% of total billed charges ,1140.38,75,,,percent of total billed charges,75% of total billed charges ,1140.38,75,,,percent of total billed charges,75% of total billed charges ,1216.4,80,,,percent of total billed charges,80% of total billed charges ,368.57,24.24,,,percent of total billed charges,24.24% of total billed charges ,766.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,1140.38,75,,,percent of total billed charges,75% of total billed charges ,372.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,408.41,26.86,,,percent of total billed charges,26.86% of total billed charges,364.92,24,,,percent of total billed charges,24% of total billed charges ,474.4,31.2,,,percent of total billed charges,31.2% of total billed charges,1216.4,80,,,percent of total billed charges,80% of total billed charges,364.92,24,,,percent of total billed charges,24% of total billed charges ,364.92,24,,,percent of total billed charges,24% of total billed charges ,364.92,1216.4,
OR LEVEL 5 OR EACH ADDL,2120079,CDM,360,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
OR LEVEL 5 MULTI PROCED,2120080,CDM,360,RC,,,Outpatient,,,361.5,180.75,,97.1,26.86,,,percent of total billed charges,26.86% of total billed charges,271.13,75,,,percent of total billed charges,75% of total billed charges ,271.13,75,,,percent of total billed charges,75% of total billed charges ,86.76,24,,,percent of total billed charges,24% of total billed charges ,271.13,75,,,percent of total billed charges,75% of total billed charges ,271.13,75,,,percent of total billed charges,75% of total billed charges ,289.2,80,,,percent of total billed charges,80% of total billed charges ,87.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,182.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,271.13,75,,,percent of total billed charges,75% of total billed charges ,88.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,97.1,26.86,,,percent of total billed charges,26.86% of total billed charges,86.76,24,,,percent of total billed charges,24% of total billed charges ,112.79,31.2,,,percent of total billed charges,31.2% of total billed charges,289.2,80,,,percent of total billed charges,80% of total billed charges,86.76,24,,,percent of total billed charges,24% of total billed charges ,86.76,24,,,percent of total billed charges,24% of total billed charges ,86.76,289.2,
LEVEL 3 ENDO INI 30M,2120081,CDM,750,RC,,,Outpatient,,,2172.5,1086.25,,583.53,26.86,,,percent of total billed charges,26.86% of total billed charges,1629.38,75,,,percent of total billed charges,75% of total billed charges ,1629.38,75,,,percent of total billed charges,75% of total billed charges ,521.4,24,,,percent of total billed charges,24% of total billed charges ,1629.38,75,,,percent of total billed charges,75% of total billed charges ,1629.38,75,,,percent of total billed charges,75% of total billed charges ,1738,80,,,percent of total billed charges,80% of total billed charges ,526.61,24.24,,,percent of total billed charges,24.24% of total billed charges ,1094.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,1629.38,75,,,percent of total billed charges,75% of total billed charges ,531.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,583.53,26.86,,,percent of total billed charges,26.86% of total billed charges,521.4,24,,,percent of total billed charges,24% of total billed charges ,677.82,31.2,,,percent of total billed charges,31.2% of total billed charges,1738,80,,,percent of total billed charges,80% of total billed charges,521.4,24,,,percent of total billed charges,24% of total billed charges ,521.4,24,,,percent of total billed charges,24% of total billed charges ,521.4,1738,
LEVEL 3 ENDO ADDL MI,2120082,CDM,750,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
LEVEL 3 ENDO MUL PRO,2120083,CDM,750,RC,,,Outpatient,,,724,362,,194.47,26.86,,,percent of total billed charges,26.86% of total billed charges,543,75,,,percent of total billed charges,75% of total billed charges ,543,75,,,percent of total billed charges,75% of total billed charges ,173.76,24,,,percent of total billed charges,24% of total billed charges ,543,75,,,percent of total billed charges,75% of total billed charges ,543,75,,,percent of total billed charges,75% of total billed charges ,579.2,80,,,percent of total billed charges,80% of total billed charges ,175.5,24.24,,,percent of total billed charges,24.24% of total billed charges ,364.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,543,75,,,percent of total billed charges,75% of total billed charges ,177.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,194.47,26.86,,,percent of total billed charges,26.86% of total billed charges,173.76,24,,,percent of total billed charges,24% of total billed charges ,225.89,31.2,,,percent of total billed charges,31.2% of total billed charges,579.2,80,,,percent of total billed charges,80% of total billed charges,173.76,24,,,percent of total billed charges,24% of total billed charges ,173.76,24,,,percent of total billed charges,24% of total billed charges ,173.76,579.2,
PERMSORB DISP FIX DE,2120084,CDM,272,RC,,,Outpatient,,,1753,876.5,,470.86,26.86,,,percent of total billed charges,26.86% of total billed charges,1314.75,75,,,percent of total billed charges,75% of total billed charges ,1314.75,75,,,percent of total billed charges,75% of total billed charges ,420.72,24,,,percent of total billed charges,24% of total billed charges ,1314.75,75,,,percent of total billed charges,75% of total billed charges ,1314.75,75,,,percent of total billed charges,75% of total billed charges ,1402.4,80,,,percent of total billed charges,80% of total billed charges ,424.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,883.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,1314.75,75,,,percent of total billed charges,75% of total billed charges ,429.13,24.48,,,percent of total billed charges,24.48% of total billed charges ,470.86,26.86,,,percent of total billed charges,26.86% of total billed charges,420.72,24,,,percent of total billed charges,24% of total billed charges ,546.94,31.2,,,percent of total billed charges,31.2% of total billed charges,1402.4,80,,,percent of total billed charges,80% of total billed charges,420.72,24,,,percent of total billed charges,24% of total billed charges ,420.72,24,,,percent of total billed charges,24% of total billed charges ,420.72,1402.4,
ENDOSCOPIC MARKER,2120085,CDM,272,RC,,,Outpatient,,,139,69.5,,37.34,26.86,,,percent of total billed charges,26.86% of total billed charges,104.25,75,,,percent of total billed charges,75% of total billed charges ,104.25,75,,,percent of total billed charges,75% of total billed charges ,33.36,24,,,percent of total billed charges,24% of total billed charges ,104.25,75,,,percent of total billed charges,75% of total billed charges ,104.25,75,,,percent of total billed charges,75% of total billed charges ,111.2,80,,,percent of total billed charges,80% of total billed charges ,33.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,70.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,104.25,75,,,percent of total billed charges,75% of total billed charges ,34.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.34,26.86,,,percent of total billed charges,26.86% of total billed charges,33.36,24,,,percent of total billed charges,24% of total billed charges ,43.37,31.2,,,percent of total billed charges,31.2% of total billed charges,111.2,80,,,percent of total billed charges,80% of total billed charges,33.36,24,,,percent of total billed charges,24% of total billed charges ,33.36,24,,,percent of total billed charges,24% of total billed charges ,33.36,111.2,
E TRAP POLYP TRAP,2120086,CDM,272,RC,,,Outpatient,,,91.5,45.75,,24.58,26.86,,,percent of total billed charges,26.86% of total billed charges,68.63,75,,,percent of total billed charges,75% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,21.96,24,,,percent of total billed charges,24% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,73.2,80,,,percent of total billed charges,80% of total billed charges ,22.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,46.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,22.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.58,26.86,,,percent of total billed charges,26.86% of total billed charges,21.96,24,,,percent of total billed charges,24% of total billed charges ,28.55,31.2,,,percent of total billed charges,31.2% of total billed charges,73.2,80,,,percent of total billed charges,80% of total billed charges,21.96,24,,,percent of total billed charges,24% of total billed charges ,21.96,24,,,percent of total billed charges,24% of total billed charges ,21.96,73.2,
ESOPH BALLOON DILATO,2120087,CDM,278,RC,C1725,HCPCS,Outpatient,,,1617,808.5,,434.33,26.86,,,percent of total billed charges,26.86% of total billed charges,1212.75,75,,,percent of total billed charges,75% of total billed charges ,1212.75,75,,,percent of total billed charges,75% of total billed charges ,388.08,24,,,percent of total billed charges,24% of total billed charges ,1212.75,75,,,percent of total billed charges,75% of total billed charges ,1212.75,75,,,percent of total billed charges,75% of total billed charges ,1293.6,80,,,percent of total billed charges,80% of total billed charges ,391.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,814.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,1212.75,75,,,percent of total billed charges,75% of total billed charges ,395.84,24.48,,,percent of total billed charges,24.48% of total billed charges ,434.33,26.86,,,percent of total billed charges,26.86% of total billed charges,388.08,24,,,percent of total billed charges,24% of total billed charges ,504.5,31.2,,,percent of total billed charges,31.2% of total billed charges,1293.6,80,,,percent of total billed charges,80% of total billed charges,388.08,24,,,percent of total billed charges,24% of total billed charges ,388.08,24,,,percent of total billed charges,24% of total billed charges ,388.08,1293.6,
REPOSITION VENOUS CA,2120088,CDM,360,RC,36597,HCPCS,Outpatient,,,187.5,93.75,,50.36,26.86,,,percent of total billed charges,26.86% of total billed charges,140.63,75,,,percent of total billed charges,75% of total billed charges ,140.63,75,,,percent of total billed charges,75% of total billed charges ,45,24,,,percent of total billed charges,24% of total billed charges ,140.63,75,,,percent of total billed charges,75% of total billed charges ,140.63,75,,,percent of total billed charges,75% of total billed charges ,150,80,,,percent of total billed charges,80% of total billed charges ,45.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,94.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,140.63,75,,,percent of total billed charges,75% of total billed charges ,45.9,24.48,,,percent of total billed charges,24.48% of total billed charges ,50.36,26.86,,,percent of total billed charges,26.86% of total billed charges,45,24,,,percent of total billed charges,24% of total billed charges ,58.5,31.2,,,percent of total billed charges,31.2% of total billed charges,150,80,,,percent of total billed charges,80% of total billed charges,45,24,,,percent of total billed charges,24% of total billed charges ,45,24,,,percent of total billed charges,24% of total billed charges ,45,150,
ALLIANCEII BALLOON,2120089,CDM,272,RC,,,Outpatient,,,283.5,141.75,,76.15,26.86,,,percent of total billed charges,26.86% of total billed charges,212.63,75,,,percent of total billed charges,75% of total billed charges ,212.63,75,,,percent of total billed charges,75% of total billed charges ,68.04,24,,,percent of total billed charges,24% of total billed charges ,212.63,75,,,percent of total billed charges,75% of total billed charges ,212.63,75,,,percent of total billed charges,75% of total billed charges ,226.8,80,,,percent of total billed charges,80% of total billed charges ,68.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,142.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,212.63,75,,,percent of total billed charges,75% of total billed charges ,69.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,76.15,26.86,,,percent of total billed charges,26.86% of total billed charges,68.04,24,,,percent of total billed charges,24% of total billed charges ,88.45,31.2,,,percent of total billed charges,31.2% of total billed charges,226.8,80,,,percent of total billed charges,80% of total billed charges,68.04,24,,,percent of total billed charges,24% of total billed charges ,68.04,24,,,percent of total billed charges,24% of total billed charges ,68.04,226.8,
ESOPHAGEAL DILATION,2120090,CDM,272,RC,,,Outpatient,,,1779,889.5,,477.84,26.86,,,percent of total billed charges,26.86% of total billed charges,1334.25,75,,,percent of total billed charges,75% of total billed charges ,1334.25,75,,,percent of total billed charges,75% of total billed charges ,426.96,24,,,percent of total billed charges,24% of total billed charges ,1334.25,75,,,percent of total billed charges,75% of total billed charges ,1334.25,75,,,percent of total billed charges,75% of total billed charges ,1423.2,80,,,percent of total billed charges,80% of total billed charges ,431.23,24.24,,,percent of total billed charges,24.24% of total billed charges ,896.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,1334.25,75,,,percent of total billed charges,75% of total billed charges ,435.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,477.84,26.86,,,percent of total billed charges,26.86% of total billed charges,426.96,24,,,percent of total billed charges,24% of total billed charges ,555.05,31.2,,,percent of total billed charges,31.2% of total billed charges,1423.2,80,,,percent of total billed charges,80% of total billed charges,426.96,24,,,percent of total billed charges,24% of total billed charges ,426.96,24,,,percent of total billed charges,24% of total billed charges ,426.96,1423.2,
EGD W/ WIRE GUIDED DILITATION,2120091,CDM,360,RC,43248,HCPCS,Outpatient,,,2798.5,1399.25,,751.68,26.86,,,percent of total billed charges,26.86% of total billed charges,2098.88,75,,,percent of total billed charges,75% of total billed charges ,2098.88,75,,,percent of total billed charges,75% of total billed charges ,671.64,24,,,percent of total billed charges,24% of total billed charges ,2098.88,75,,,percent of total billed charges,75% of total billed charges ,2098.88,75,,,percent of total billed charges,75% of total billed charges ,2238.8,80,,,percent of total billed charges,80% of total billed charges ,678.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,1410.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,2098.88,75,,,percent of total billed charges,75% of total billed charges ,685.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,751.68,26.86,,,percent of total billed charges,26.86% of total billed charges,671.64,24,,,percent of total billed charges,24% of total billed charges ,873.13,31.2,,,percent of total billed charges,31.2% of total billed charges,2238.8,80,,,percent of total billed charges,80% of total billed charges,671.64,24,,,percent of total billed charges,24% of total billed charges ,671.64,24,,,percent of total billed charges,24% of total billed charges ,671.64,2238.8,
INTRO OF CATHETER SUPERIOR OR VENA CAVA,2120092,CDM,360,RC,36010,HCPCS,Outpatient,,,836.5,418.25,,224.68,26.86,,,percent of total billed charges,26.86% of total billed charges,627.38,75,,,percent of total billed charges,75% of total billed charges ,627.38,75,,,percent of total billed charges,75% of total billed charges ,200.76,24,,,percent of total billed charges,24% of total billed charges ,627.38,75,,,percent of total billed charges,75% of total billed charges ,627.38,75,,,percent of total billed charges,75% of total billed charges ,669.2,80,,,percent of total billed charges,80% of total billed charges ,202.77,24.24,,,percent of total billed charges,24.24% of total billed charges ,421.6,50.4,,,percent of total billed charges,50.4% of total billed charges ,627.38,75,,,percent of total billed charges,75% of total billed charges ,204.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,224.68,26.86,,,percent of total billed charges,26.86% of total billed charges,200.76,24,,,percent of total billed charges,24% of total billed charges ,260.99,31.2,,,percent of total billed charges,31.2% of total billed charges,669.2,80,,,percent of total billed charges,80% of total billed charges,200.76,24,,,percent of total billed charges,24% of total billed charges ,200.76,24,,,percent of total billed charges,24% of total billed charges ,200.76,669.2,
VENOGRAPHY,2120093,CDM,360,RC,75825,HCPCS,Outpatient,,,758,379,,203.6,26.86,,,percent of total billed charges,26.86% of total billed charges,568.5,75,,,percent of total billed charges,75% of total billed charges ,568.5,75,,,percent of total billed charges,75% of total billed charges ,181.92,24,,,percent of total billed charges,24% of total billed charges ,568.5,75,,,percent of total billed charges,75% of total billed charges ,568.5,75,,,percent of total billed charges,75% of total billed charges ,606.4,80,,,percent of total billed charges,80% of total billed charges ,183.74,24.24,,,percent of total billed charges,24.24% of total billed charges ,382.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,568.5,75,,,percent of total billed charges,75% of total billed charges ,185.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,203.6,26.86,,,percent of total billed charges,26.86% of total billed charges,181.92,24,,,percent of total billed charges,24% of total billed charges ,236.5,31.2,,,percent of total billed charges,31.2% of total billed charges,606.4,80,,,percent of total billed charges,80% of total billed charges,181.92,24,,,percent of total billed charges,24% of total billed charges ,181.92,24,,,percent of total billed charges,24% of total billed charges ,181.92,606.4,
T-TUBE,2127709,CDM,272,RC,,,Outpatient,,,127.5,63.75,,34.25,26.86,,,percent of total billed charges,26.86% of total billed charges,95.63,75,,,percent of total billed charges,75% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,30.6,24,,,percent of total billed charges,24% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,102,80,,,percent of total billed charges,80% of total billed charges ,30.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,64.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,31.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,34.25,26.86,,,percent of total billed charges,26.86% of total billed charges,30.6,24,,,percent of total billed charges,24% of total billed charges ,39.78,31.2,,,percent of total billed charges,31.2% of total billed charges,102,80,,,percent of total billed charges,80% of total billed charges,30.6,24,,,percent of total billed charges,24% of total billed charges ,30.6,24,,,percent of total billed charges,24% of total billed charges ,30.6,102,
BREAST BIOPSY,2140011,CDM,360,RC,400,HCPCS,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
EGD W/ BX,2143239,CDM,360,RC,43239,HCPCS,Outpatient,,,941.5,470.75,,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,753.2,80,,,percent of total billed charges,80% of total billed charges ,228.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,474.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,230.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,293.75,31.2,,,percent of total billed charges,31.2% of total billed charges,753.2,80,,,percent of total billed charges,80% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,753.2,
EGD W/ UNGUIDED DILITATION,2143450,CDM,360,RC,43450,HCPCS,Outpatient,,,941.5,470.75,,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,753.2,80,,,percent of total billed charges,80% of total billed charges ,228.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,474.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,230.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,293.75,31.2,,,percent of total billed charges,31.2% of total billed charges,753.2,80,,,percent of total billed charges,80% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,753.2,
FLEX SIG W/ BX,2145331,CDM,360,RC,45331,HCPCS,Outpatient,,,941.5,470.75,,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,753.2,80,,,percent of total billed charges,80% of total billed charges ,228.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,474.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,230.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,293.75,31.2,,,percent of total billed charges,31.2% of total billed charges,753.2,80,,,percent of total billed charges,80% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,753.2,
C-SCOPE W/ BX,2145380,CDM,360,RC,45380,HCPCS,Outpatient,,,941.5,470.75,,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,753.2,80,,,percent of total billed charges,80% of total billed charges ,228.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,474.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,230.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,293.75,31.2,,,percent of total billed charges,31.2% of total billed charges,753.2,80,,,percent of total billed charges,80% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,753.2,
C-SCOPE W/ SNARE,2145385,CDM,360,RC,45385,HCPCS,Outpatient,,,941.5,470.75,,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,753.2,80,,,percent of total billed charges,80% of total billed charges ,228.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,474.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,230.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,293.75,31.2,,,percent of total billed charges,31.2% of total billed charges,753.2,80,,,percent of total billed charges,80% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,753.2,
HEM BANDING,2146221,CDM,360,RC,46221,HCPCS,Outpatient,,,941.5,470.75,,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,753.2,80,,,percent of total billed charges,80% of total billed charges ,228.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,474.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,706.13,75,,,percent of total billed charges,75% of total billed charges ,230.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,252.89,26.86,,,percent of total billed charges,26.86% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,293.75,31.2,,,percent of total billed charges,31.2% of total billed charges,753.2,80,,,percent of total billed charges,80% of total billed charges,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,24,,,percent of total billed charges,24% of total billed charges ,225.96,753.2,
PROLOOP MESH LARGE,2146222,CDM,278,RC,C1781,HCPCS,Outpatient,,,424.5,212.25,,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,424.5,75,,,percent of total billed charges,75% of total billed charges ,424.5,75,,,percent of total billed charges,75% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,424.5,75,,,percent of total billed charges,75% of total billed charges ,424.5,75,,,percent of total billed charges,75% of total billed charges ,339.6,80,,,percent of total billed charges,80% of total billed charges ,102.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,213.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,103.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,132.44,31.2,,,percent of total billed charges,31.2% of total billed charges,339.6,80,,,percent of total billed charges,80% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,424.5,
PROLOOP MESH MEDIUM,2146223,CDM,278,RC,C1781,HCPCS,Outpatient,,,424.5,212.25,,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,424.5,75,,,percent of total billed charges,75% of total billed charges ,424.5,75,,,percent of total billed charges,75% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,424.5,75,,,percent of total billed charges,75% of total billed charges ,424.5,75,,,percent of total billed charges,75% of total billed charges ,339.6,80,,,percent of total billed charges,80% of total billed charges ,102.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,213.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,103.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,132.44,31.2,,,percent of total billed charges,31.2% of total billed charges,339.6,80,,,percent of total billed charges,80% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,424.5,
GRANEE NEEDLE,2146224,CDM,272,RC,,,Outpatient,,,104,52,,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,83.2,80,,,percent of total billed charges,80% of total billed charges ,25.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,25.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,32.45,31.2,,,percent of total billed charges,31.2% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,83.2,
PPH STAPLE GUN,2146225,CDM,272,RC,,,Outpatient,,,980.5,490.25,,263.36,26.86,,,percent of total billed charges,26.86% of total billed charges,735.38,75,,,percent of total billed charges,75% of total billed charges ,735.38,75,,,percent of total billed charges,75% of total billed charges ,235.32,24,,,percent of total billed charges,24% of total billed charges ,735.38,75,,,percent of total billed charges,75% of total billed charges ,735.38,75,,,percent of total billed charges,75% of total billed charges ,784.4,80,,,percent of total billed charges,80% of total billed charges ,237.67,24.24,,,percent of total billed charges,24.24% of total billed charges ,494.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,735.38,75,,,percent of total billed charges,75% of total billed charges ,240.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,263.36,26.86,,,percent of total billed charges,26.86% of total billed charges,235.32,24,,,percent of total billed charges,24% of total billed charges ,305.92,31.2,,,percent of total billed charges,31.2% of total billed charges,784.4,80,,,percent of total billed charges,80% of total billed charges,235.32,24,,,percent of total billed charges,24% of total billed charges ,235.32,24,,,percent of total billed charges,24% of total billed charges ,235.32,784.4,
C-QUR/TACSHIELD MESH 4X6,2146226,CDM,278,RC,C1781,HCPCS,Outpatient,,,2467,1233.5,,662.64,26.86,,,percent of total billed charges,26.86% of total billed charges,1850.25,75,,,percent of total billed charges,75% of total billed charges ,1850.25,75,,,percent of total billed charges,75% of total billed charges ,592.08,24,,,percent of total billed charges,24% of total billed charges ,1850.25,75,,,percent of total billed charges,75% of total billed charges ,1850.25,75,,,percent of total billed charges,75% of total billed charges ,1973.6,80,,,percent of total billed charges,80% of total billed charges ,598,24.24,,,percent of total billed charges,24.24% of total billed charges ,1243.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,1850.25,75,,,percent of total billed charges,75% of total billed charges ,603.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,662.64,26.86,,,percent of total billed charges,26.86% of total billed charges,592.08,24,,,percent of total billed charges,24% of total billed charges ,769.7,31.2,,,percent of total billed charges,31.2% of total billed charges,1973.6,80,,,percent of total billed charges,80% of total billed charges,592.08,24,,,percent of total billed charges,24% of total billed charges ,592.08,24,,,percent of total billed charges,24% of total billed charges ,592.08,1973.6,
PROLENE MESH PMII 3X6,2146227,CDM,278,RC,C1781,HCPCS,Outpatient,,,507,253.5,,136.18,26.86,,,percent of total billed charges,26.86% of total billed charges,507,75,,,percent of total billed charges,75% of total billed charges ,507,75,,,percent of total billed charges,75% of total billed charges ,121.68,24,,,percent of total billed charges,24% of total billed charges ,507,75,,,percent of total billed charges,75% of total billed charges ,507,75,,,percent of total billed charges,75% of total billed charges ,405.6,80,,,percent of total billed charges,80% of total billed charges ,122.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,255.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,380.25,75,,,percent of total billed charges,75% of total billed charges ,124.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,136.18,26.86,,,percent of total billed charges,26.86% of total billed charges,121.68,24,,,percent of total billed charges,24% of total billed charges ,158.18,31.2,,,percent of total billed charges,31.2% of total billed charges,405.6,80,,,percent of total billed charges,80% of total billed charges,121.68,24,,,percent of total billed charges,24% of total billed charges ,121.68,24,,,percent of total billed charges,24% of total billed charges ,121.68,507,
FLEX SIGMOID,2190000,CDM,360,RC,,,Outpatient,,,564.5,282.25,,151.62,26.86,,,percent of total billed charges,26.86% of total billed charges,423.38,75,,,percent of total billed charges,75% of total billed charges ,423.38,75,,,percent of total billed charges,75% of total billed charges ,135.48,24,,,percent of total billed charges,24% of total billed charges ,423.38,75,,,percent of total billed charges,75% of total billed charges ,423.38,75,,,percent of total billed charges,75% of total billed charges ,451.6,80,,,percent of total billed charges,80% of total billed charges ,136.83,24.24,,,percent of total billed charges,24.24% of total billed charges ,284.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,423.38,75,,,percent of total billed charges,75% of total billed charges ,138.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,151.62,26.86,,,percent of total billed charges,26.86% of total billed charges,135.48,24,,,percent of total billed charges,24% of total billed charges ,176.12,31.2,,,percent of total billed charges,31.2% of total billed charges,451.6,80,,,percent of total billed charges,80% of total billed charges,135.48,24,,,percent of total billed charges,24% of total billed charges ,135.48,24,,,percent of total billed charges,24% of total billed charges ,135.48,451.6,
ENDO LINEAR RELOAD ETS45,2190001,CDM,360,RC,,,Outpatient,,,610,305,,163.85,26.86,,,percent of total billed charges,26.86% of total billed charges,457.5,75,,,percent of total billed charges,75% of total billed charges ,457.5,75,,,percent of total billed charges,75% of total billed charges ,146.4,24,,,percent of total billed charges,24% of total billed charges ,457.5,75,,,percent of total billed charges,75% of total billed charges ,457.5,75,,,percent of total billed charges,75% of total billed charges ,488,80,,,percent of total billed charges,80% of total billed charges ,147.86,24.24,,,percent of total billed charges,24.24% of total billed charges ,307.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,457.5,75,,,percent of total billed charges,75% of total billed charges ,149.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,163.85,26.86,,,percent of total billed charges,26.86% of total billed charges,146.4,24,,,percent of total billed charges,24% of total billed charges ,190.32,31.2,,,percent of total billed charges,31.2% of total billed charges,488,80,,,percent of total billed charges,80% of total billed charges,146.4,24,,,percent of total billed charges,24% of total billed charges ,146.4,24,,,percent of total billed charges,24% of total billed charges ,146.4,488,
VENTIMASK,2190002,CDM,360,RC,,,Outpatient,,,11.5,5.75,,3.09,26.86,,,percent of total billed charges,26.86% of total billed charges,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,9.2,80,,,percent of total billed charges,80% of total billed charges ,2.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.09,26.86,,,percent of total billed charges,26.86% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,3.59,31.2,,,percent of total billed charges,31.2% of total billed charges,9.2,80,,,percent of total billed charges,80% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,9.2,
PACU INITAL 30 MINUT,2230000,CDM,710,RC,,,Outpatient,,,1060,530,,284.72,26.86,,,percent of total billed charges,26.86% of total billed charges,795,75,,,percent of total billed charges,75% of total billed charges ,795,75,,,percent of total billed charges,75% of total billed charges ,254.4,24,,,percent of total billed charges,24% of total billed charges ,795,75,,,percent of total billed charges,75% of total billed charges ,795,75,,,percent of total billed charges,75% of total billed charges ,848,80,,,percent of total billed charges,80% of total billed charges ,256.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,534.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,795,75,,,percent of total billed charges,75% of total billed charges ,259.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,284.72,26.86,,,percent of total billed charges,26.86% of total billed charges,254.4,24,,,percent of total billed charges,24% of total billed charges ,330.72,31.2,,,percent of total billed charges,31.2% of total billed charges,848,80,,,percent of total billed charges,80% of total billed charges,254.4,24,,,percent of total billed charges,24% of total billed charges ,254.4,24,,,percent of total billed charges,24% of total billed charges ,254.4,848,
RECOVERY O/P SURGERY,2230001,CDM,710,RC,,,Outpatient,,,847.5,423.75,,227.64,26.86,,,percent of total billed charges,26.86% of total billed charges,635.63,75,,,percent of total billed charges,75% of total billed charges ,635.63,75,,,percent of total billed charges,75% of total billed charges ,203.4,24,,,percent of total billed charges,24% of total billed charges ,635.63,75,,,percent of total billed charges,75% of total billed charges ,635.63,75,,,percent of total billed charges,75% of total billed charges ,678,80,,,percent of total billed charges,80% of total billed charges ,205.43,24.24,,,percent of total billed charges,24.24% of total billed charges ,427.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,635.63,75,,,percent of total billed charges,75% of total billed charges ,207.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,227.64,26.86,,,percent of total billed charges,26.86% of total billed charges,203.4,24,,,percent of total billed charges,24% of total billed charges ,264.42,31.2,,,percent of total billed charges,31.2% of total billed charges,678,80,,,percent of total billed charges,80% of total billed charges,203.4,24,,,percent of total billed charges,24% of total billed charges ,203.4,24,,,percent of total billed charges,24% of total billed charges ,203.4,678,
PACU EACH ADDL MINUT,2230002,CDM,710,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
RPR SIMPLE LAC F/E/E/N/L 7.6-12.5CM,2300018,CDM,450,RC,12015,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR S/N/AX/GEN/TRK 7.6-12.5CM,2300591,CDM,450,RC,12004,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
ER SCREENING FEE,2310005,CDM,450,RC,99281,HCPCS,Outpatient,,,57.5,28.75,,15.44,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,13.8,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,46,80,,,percent of total billed charges,80% of total billed charges ,13.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,14.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.44,26.86,,,percent of total billed charges,26.86% of total billed charges,13.8,24,,,percent of total billed charges,24% of total billed charges ,17.94,31.2,,,percent of total billed charges,31.2% of total billed charges,46,80,,,percent of total billed charges,80% of total billed charges,13.8,24,,,percent of total billed charges,24% of total billed charges ,13.8,24,,,percent of total billed charges,24% of total billed charges ,13.8,710,
OBSERVATION ROOM RATE,2310006,CDM,762,RC,99218,HCPCS,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
OBSERVATION AUTO OBS,2310007,CDM,762,RC,99218,HCPCS,Outpatient,,,116.5,58.25,,31.29,26.86,,,percent of total billed charges,26.86% of total billed charges,87.38,75,,,percent of total billed charges,75% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,27.96,24,,,percent of total billed charges,24% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,93.2,80,,,percent of total billed charges,80% of total billed charges ,28.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,58.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,28.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.29,26.86,,,percent of total billed charges,26.86% of total billed charges,27.96,24,,,percent of total billed charges,24% of total billed charges ,36.35,31.2,,,percent of total billed charges,31.2% of total billed charges,93.2,80,,,percent of total billed charges,80% of total billed charges,27.96,24,,,percent of total billed charges,24% of total billed charges ,27.96,24,,,percent of total billed charges,24% of total billed charges ,27.96,93.2,
EMERGENCY ROOM LEVEL I,2310024,CDM,450,RC,99281,HCPCS,Outpatient,,,414,207,,111.2,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,99.36,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,331.2,80,,,percent of total billed charges,80% of total billed charges ,100.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,208.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,310.5,75,,,percent of total billed charges,75% of total billed charges ,101.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,111.2,26.86,,,percent of total billed charges,26.86% of total billed charges,99.36,24,,,percent of total billed charges,24% of total billed charges ,129.17,31.2,,,percent of total billed charges,31.2% of total billed charges,331.2,80,,,percent of total billed charges,80% of total billed charges,99.36,24,,,percent of total billed charges,24% of total billed charges ,99.36,24,,,percent of total billed charges,24% of total billed charges ,99.36,710,
EMERGENCY ROOM LEVEL II,2310025,CDM,450,RC,99282,HCPCS,Outpatient,,,530.5,265.25,,142.49,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,127.32,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,424.4,80,,,percent of total billed charges,80% of total billed charges ,128.59,24.24,,,percent of total billed charges,24.24% of total billed charges ,267.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,397.88,75,,,percent of total billed charges,75% of total billed charges ,129.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,142.49,26.86,,,percent of total billed charges,26.86% of total billed charges,127.32,24,,,percent of total billed charges,24% of total billed charges ,165.52,31.2,,,percent of total billed charges,31.2% of total billed charges,424.4,80,,,percent of total billed charges,80% of total billed charges,127.32,24,,,percent of total billed charges,24% of total billed charges ,127.32,24,,,percent of total billed charges,24% of total billed charges ,127.32,710,
EMERGENCY ROOM LEVEL III,2310026,CDM,450,RC,99283,HCPCS,Outpatient,,,721,360.5,,193.66,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,173.04,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,576.8,80,,,percent of total billed charges,80% of total billed charges ,174.77,24.24,,,percent of total billed charges,24.24% of total billed charges ,363.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,540.75,75,,,percent of total billed charges,75% of total billed charges ,176.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,193.66,26.86,,,percent of total billed charges,26.86% of total billed charges,173.04,24,,,percent of total billed charges,24% of total billed charges ,224.95,31.2,,,percent of total billed charges,31.2% of total billed charges,576.8,80,,,percent of total billed charges,80% of total billed charges,173.04,24,,,percent of total billed charges,24% of total billed charges ,173.04,24,,,percent of total billed charges,24% of total billed charges ,173.04,710,
EMERGENCY ROOM LEVEL IV,2310027,CDM,450,RC,99284,HCPCS,Outpatient,,,981.5,490.75,,263.63,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,235.56,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,785.2,80,,,percent of total billed charges,80% of total billed charges ,237.92,24.24,,,percent of total billed charges,24.24% of total billed charges ,494.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,736.13,75,,,percent of total billed charges,75% of total billed charges ,240.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,263.63,26.86,,,percent of total billed charges,26.86% of total billed charges,235.56,24,,,percent of total billed charges,24% of total billed charges ,306.23,31.2,,,percent of total billed charges,31.2% of total billed charges,785.2,80,,,percent of total billed charges,80% of total billed charges,235.56,24,,,percent of total billed charges,24% of total billed charges ,235.56,24,,,percent of total billed charges,24% of total billed charges ,235.56,785.2,
EMERGENCY ROOM LEVEL V,2310028,CDM,450,RC,99285,HCPCS,Outpatient,,,1326.5,663.25,,356.3,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,318.36,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,1061.2,80,,,percent of total billed charges,80% of total billed charges ,321.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,668.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,994.88,75,,,percent of total billed charges,75% of total billed charges ,324.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,356.3,26.86,,,percent of total billed charges,26.86% of total billed charges,318.36,24,,,percent of total billed charges,24% of total billed charges ,413.87,31.2,,,percent of total billed charges,31.2% of total billed charges,1061.2,80,,,percent of total billed charges,80% of total billed charges,318.36,24,,,percent of total billed charges,24% of total billed charges ,318.36,24,,,percent of total billed charges,24% of total billed charges ,318.36,1061.2,
EMERGENCY ROOM LEVEL I -25,2310029,CDM,450,RC,99281,HCPCS,Outpatient,,,414,207,,111.2,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,99.36,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,331.2,80,,,percent of total billed charges,80% of total billed charges ,100.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,208.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,310.5,75,,,percent of total billed charges,75% of total billed charges ,101.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,111.2,26.86,,,percent of total billed charges,26.86% of total billed charges,99.36,24,,,percent of total billed charges,24% of total billed charges ,129.17,31.2,,,percent of total billed charges,31.2% of total billed charges,331.2,80,,,percent of total billed charges,80% of total billed charges,99.36,24,,,percent of total billed charges,24% of total billed charges ,99.36,24,,,percent of total billed charges,24% of total billed charges ,99.36,710,
EMERGENCY ROOM LEVEL II -25,2310030,CDM,450,RC,99282,HCPCS,Outpatient,,,530.5,265.25,,142.49,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,127.32,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,424.4,80,,,percent of total billed charges,80% of total billed charges ,128.59,24.24,,,percent of total billed charges,24.24% of total billed charges ,267.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,397.88,75,,,percent of total billed charges,75% of total billed charges ,129.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,142.49,26.86,,,percent of total billed charges,26.86% of total billed charges,127.32,24,,,percent of total billed charges,24% of total billed charges ,165.52,31.2,,,percent of total billed charges,31.2% of total billed charges,424.4,80,,,percent of total billed charges,80% of total billed charges,127.32,24,,,percent of total billed charges,24% of total billed charges ,127.32,24,,,percent of total billed charges,24% of total billed charges ,127.32,710,
EMERGENCY ROOM LEVEL III -25,2310031,CDM,450,RC,99283,HCPCS,Outpatient,,,721,360.5,,193.66,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,173.04,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,576.8,80,,,percent of total billed charges,80% of total billed charges ,174.77,24.24,,,percent of total billed charges,24.24% of total billed charges ,363.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,540.75,75,,,percent of total billed charges,75% of total billed charges ,176.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,193.66,26.86,,,percent of total billed charges,26.86% of total billed charges,173.04,24,,,percent of total billed charges,24% of total billed charges ,224.95,31.2,,,percent of total billed charges,31.2% of total billed charges,576.8,80,,,percent of total billed charges,80% of total billed charges,173.04,24,,,percent of total billed charges,24% of total billed charges ,173.04,24,,,percent of total billed charges,24% of total billed charges ,173.04,710,
EMERGENCY ROOM LEVEL IV -25,2310032,CDM,450,RC,99284,HCPCS,Outpatient,,,981.5,490.75,,263.63,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,235.56,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,785.2,80,,,percent of total billed charges,80% of total billed charges ,237.92,24.24,,,percent of total billed charges,24.24% of total billed charges ,494.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,736.13,75,,,percent of total billed charges,75% of total billed charges ,240.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,263.63,26.86,,,percent of total billed charges,26.86% of total billed charges,235.56,24,,,percent of total billed charges,24% of total billed charges ,306.23,31.2,,,percent of total billed charges,31.2% of total billed charges,785.2,80,,,percent of total billed charges,80% of total billed charges,235.56,24,,,percent of total billed charges,24% of total billed charges ,235.56,24,,,percent of total billed charges,24% of total billed charges ,235.56,785.2,
EMERGENCY ROOM LEVEL V -25,2310033,CDM,450,RC,99285,HCPCS,Outpatient,,,1326.5,663.25,,356.3,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,318.36,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,1061.2,80,,,percent of total billed charges,80% of total billed charges ,321.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,668.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,994.88,75,,,percent of total billed charges,75% of total billed charges ,324.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,356.3,26.86,,,percent of total billed charges,26.86% of total billed charges,318.36,24,,,percent of total billed charges,24% of total billed charges ,413.87,31.2,,,percent of total billed charges,31.2% of total billed charges,1061.2,80,,,percent of total billed charges,80% of total billed charges,318.36,24,,,percent of total billed charges,24% of total billed charges ,318.36,24,,,percent of total billed charges,24% of total billed charges ,318.36,1061.2,
ER NO CHARGE VISIT,2310035,CDM,450,RC,,,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
DRAINAGE GUM LESION,2330051,CDM,450,RC,41800,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
BAMLANIVIMAB INFUSION/MONITORING,2330100,CDM,771,RC,M0245,HCPCS,Outpatient,,,636.5,318.25,,170.96,26.86,,,percent of total billed charges,26.86% of total billed charges,477.38,75,,,percent of total billed charges,75% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,152.76,24,,,percent of total billed charges,24% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,509.2,80,,,percent of total billed charges,80% of total billed charges ,154.29,24.24,,,percent of total billed charges,24.24% of total billed charges ,320.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,155.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,170.96,26.86,,,percent of total billed charges,26.86% of total billed charges,152.76,24,,,percent of total billed charges,24% of total billed charges ,198.59,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,152.76,24,,,percent of total billed charges,24% of total billed charges ,152.76,24,,,percent of total billed charges,24% of total billed charges ,152.76,509.2,
BAM/ETESEVIMAB INFUSION/MONITORING,2330101,CDM,771,RC,M0245,HCPCS,Outpatient,,,636.5,318.25,,170.96,26.86,,,percent of total billed charges,26.86% of total billed charges,477.38,75,,,percent of total billed charges,75% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,152.76,24,,,percent of total billed charges,24% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,509.2,80,,,percent of total billed charges,80% of total billed charges ,154.29,24.24,,,percent of total billed charges,24.24% of total billed charges ,320.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,477.38,75,,,percent of total billed charges,75% of total billed charges ,155.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,170.96,26.86,,,percent of total billed charges,26.86% of total billed charges,152.76,24,,,percent of total billed charges,24% of total billed charges ,198.59,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,152.76,24,,,percent of total billed charges,24% of total billed charges ,152.76,24,,,percent of total billed charges,24% of total billed charges ,152.76,509.2,
IO ACCESS CATHETER,2330492,CDM,272,RC,,,Outpatient,,,949.5,474.75,,255.04,26.86,,,percent of total billed charges,26.86% of total billed charges,712.13,75,,,percent of total billed charges,75% of total billed charges ,712.13,75,,,percent of total billed charges,75% of total billed charges ,227.88,24,,,percent of total billed charges,24% of total billed charges ,712.13,75,,,percent of total billed charges,75% of total billed charges ,712.13,75,,,percent of total billed charges,75% of total billed charges ,759.6,80,,,percent of total billed charges,80% of total billed charges ,230.16,24.24,,,percent of total billed charges,24.24% of total billed charges ,478.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,712.13,75,,,percent of total billed charges,75% of total billed charges ,232.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,255.04,26.86,,,percent of total billed charges,26.86% of total billed charges,227.88,24,,,percent of total billed charges,24% of total billed charges ,296.24,31.2,,,percent of total billed charges,31.2% of total billed charges,759.6,80,,,percent of total billed charges,80% of total billed charges,227.88,24,,,percent of total billed charges,24% of total billed charges ,227.88,24,,,percent of total billed charges,24% of total billed charges ,227.88,759.6,
IO PLACEMENT,2330493,CDM,450,RC,36680,HCPCS,Outpatient,,,443,221.5,,118.99,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,106.32,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,354.4,80,,,percent of total billed charges,80% of total billed charges ,107.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,223.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,332.25,75,,,percent of total billed charges,75% of total billed charges ,108.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,118.99,26.86,,,percent of total billed charges,26.86% of total billed charges,106.32,24,,,percent of total billed charges,24% of total billed charges ,138.22,31.2,,,percent of total billed charges,31.2% of total billed charges,354.4,80,,,percent of total billed charges,80% of total billed charges,106.32,24,,,percent of total billed charges,24% of total billed charges ,106.32,24,,,percent of total billed charges,24% of total billed charges ,106.32,710,
EZ STABILIZER,2330494,CDM,272,RC,,,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
PORT-A-CATH BLOOD DRAW,2330495,CDM,450,RC,36591,HCPCS,Outpatient,,,54.5,27.25,,14.64,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,13.08,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,43.6,80,,,percent of total billed charges,80% of total billed charges ,13.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,27.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,13.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.64,26.86,,,percent of total billed charges,26.86% of total billed charges,13.08,24,,,percent of total billed charges,24% of total billed charges ,17,31.2,,,percent of total billed charges,31.2% of total billed charges,43.6,80,,,percent of total billed charges,80% of total billed charges,13.08,24,,,percent of total billed charges,24% of total billed charges ,13.08,24,,,percent of total billed charges,24% of total billed charges ,13.08,710,
BURN CARE FIRST DEGREE,2330496,CDM,450,RC,16000,HCPCS,Outpatient,,,108,54,,29.01,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.01,26.86,,,percent of total billed charges,26.86% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,710,
CPR,2330497,CDM,450,RC,92950,HCPCS,Outpatient,,,762,381,,204.67,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,182.88,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,609.6,80,,,percent of total billed charges,80% of total billed charges ,184.71,24.24,,,percent of total billed charges,24.24% of total billed charges ,384.05,50.4,,,percent of total billed charges,50.4% of total billed charges ,571.5,75,,,percent of total billed charges,75% of total billed charges ,186.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,204.67,26.86,,,percent of total billed charges,26.86% of total billed charges,182.88,24,,,percent of total billed charges,24% of total billed charges ,237.74,31.2,,,percent of total billed charges,31.2% of total billed charges,609.6,80,,,percent of total billed charges,80% of total billed charges,182.88,24,,,percent of total billed charges,24% of total billed charges ,182.88,24,,,percent of total billed charges,24% of total billed charges ,182.88,710,
CARDIAC MONITORING,2330498,CDM,730,RC,93041,HCPCS,Outpatient,,,383,191.5,,102.87,26.86,,,percent of total billed charges,26.86% of total billed charges,287.25,75,,,percent of total billed charges,75% of total billed charges ,287.25,75,,,percent of total billed charges,75% of total billed charges ,91.92,24,,,percent of total billed charges,24% of total billed charges ,287.25,75,,,percent of total billed charges,75% of total billed charges ,287.25,75,,,percent of total billed charges,75% of total billed charges ,306.4,80,,,percent of total billed charges,80% of total billed charges ,92.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,193.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,287.25,75,,,percent of total billed charges,75% of total billed charges ,93.76,24.48,,,percent of total billed charges,24.48% of total billed charges ,102.87,26.86,,,percent of total billed charges,26.86% of total billed charges,91.92,24,,,percent of total billed charges,24% of total billed charges ,119.5,31.2,,,percent of total billed charges,31.2% of total billed charges,306.4,80,,,percent of total billed charges,80% of total billed charges,91.92,24,,,percent of total billed charges,24% of total billed charges ,91.92,24,,,percent of total billed charges,24% of total billed charges ,91.92,306.4,
CARDIOVERSION EXTERNAL,2330499,CDM,450,RC,92960,HCPCS,Outpatient,,,790,395,,212.19,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,189.6,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,632,80,,,percent of total billed charges,80% of total billed charges ,191.5,24.24,,,percent of total billed charges,24.24% of total billed charges ,398.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,592.5,75,,,percent of total billed charges,75% of total billed charges ,193.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,212.19,26.86,,,percent of total billed charges,26.86% of total billed charges,189.6,24,,,percent of total billed charges,24% of total billed charges ,246.48,31.2,,,percent of total billed charges,31.2% of total billed charges,632,80,,,percent of total billed charges,80% of total billed charges,189.6,24,,,percent of total billed charges,24% of total billed charges ,189.6,24,,,percent of total billed charges,24% of total billed charges ,189.6,710,
CENTRAL LINE INSERTION,2330500,CDM,450,RC,36556,HCPCS,Outpatient,,,1045.5,522.75,,280.82,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,250.92,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,836.4,80,,,percent of total billed charges,80% of total billed charges ,253.43,24.24,,,percent of total billed charges,24.24% of total billed charges ,526.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,784.13,75,,,percent of total billed charges,75% of total billed charges ,255.94,24.48,,,percent of total billed charges,24.48% of total billed charges ,280.82,26.86,,,percent of total billed charges,26.86% of total billed charges,250.92,24,,,percent of total billed charges,24% of total billed charges ,326.2,31.2,,,percent of total billed charges,31.2% of total billed charges,836.4,80,,,percent of total billed charges,80% of total billed charges,250.92,24,,,percent of total billed charges,24% of total billed charges ,250.92,24,,,percent of total billed charges,24% of total billed charges ,250.92,836.4,
CONSCIOUS SEDATION,2330502,CDM,450,RC,99152,HCPCS,Outpatient,,,557,278.5,,149.61,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,133.68,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,445.6,80,,,percent of total billed charges,80% of total billed charges ,135.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,280.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,417.75,75,,,percent of total billed charges,75% of total billed charges ,136.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,149.61,26.86,,,percent of total billed charges,26.86% of total billed charges,133.68,24,,,percent of total billed charges,24% of total billed charges ,173.78,31.2,,,percent of total billed charges,31.2% of total billed charges,445.6,80,,,percent of total billed charges,80% of total billed charges,133.68,24,,,percent of total billed charges,24% of total billed charges ,133.68,24,,,percent of total billed charges,24% of total billed charges ,133.68,710,
IN AND OUT CATH,2330503,CDM,450,RC,P9612,HCPCS,Outpatient,,,57.5,28.75,,15.44,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,13.8,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,46,80,,,percent of total billed charges,80% of total billed charges ,13.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,14.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.44,26.86,,,percent of total billed charges,26.86% of total billed charges,13.8,24,,,percent of total billed charges,24% of total billed charges ,17.94,31.2,,,percent of total billed charges,31.2% of total billed charges,46,80,,,percent of total billed charges,80% of total billed charges,13.8,24,,,percent of total billed charges,24% of total billed charges ,13.8,24,,,percent of total billed charges,24% of total billed charges ,13.8,710,
IV HEPLOCK ONLY,2330504,CDM,260,RC,36000,HCPCS,Outpatient,,,87.5,43.75,,23.5,26.86,,,percent of total billed charges,26.86% of total billed charges,65.63,75,,,percent of total billed charges,75% of total billed charges ,65.63,75,,,percent of total billed charges,75% of total billed charges ,21,24,,,percent of total billed charges,24% of total billed charges ,65.63,75,,,percent of total billed charges,75% of total billed charges ,65.63,75,,,percent of total billed charges,75% of total billed charges ,70,80,,,percent of total billed charges,80% of total billed charges ,21.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,44.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,65.63,75,,,percent of total billed charges,75% of total billed charges ,21.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.5,26.86,,,percent of total billed charges,26.86% of total billed charges,21,24,,,percent of total billed charges,24% of total billed charges ,27.3,31.2,,,percent of total billed charges,31.2% of total billed charges,70,80,,,percent of total billed charges,80% of total billed charges,21,24,,,percent of total billed charges,24% of total billed charges ,21,24,,,percent of total billed charges,24% of total billed charges ,21,70,
GASTRIC INTUBATION LAVAGE,2330505,CDM,450,RC,43753,HCPCS,Outpatient,,,355.5,177.75,,95.49,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,85.32,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,284.4,80,,,percent of total billed charges,80% of total billed charges ,86.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,266.63,75,,,percent of total billed charges,75% of total billed charges ,87.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.49,26.86,,,percent of total billed charges,26.86% of total billed charges,85.32,24,,,percent of total billed charges,24% of total billed charges ,110.92,31.2,,,percent of total billed charges,31.2% of total billed charges,284.4,80,,,percent of total billed charges,80% of total billed charges,85.32,24,,,percent of total billed charges,24% of total billed charges ,85.32,24,,,percent of total billed charges,24% of total billed charges ,85.32,710,
VACCINE/TOXOID TETANUS,2330506,CDM,771,RC,90471,HCPCS,Outpatient,,,80.5,40.25,,21.62,26.86,,,percent of total billed charges,26.86% of total billed charges,60.38,75,,,percent of total billed charges,75% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,19.32,24,,,percent of total billed charges,24% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,64.4,80,,,percent of total billed charges,80% of total billed charges ,19.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,40.57,50.4,,,percent of total billed charges,50.4% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,19.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.62,26.86,,,percent of total billed charges,26.86% of total billed charges,19.32,24,,,percent of total billed charges,24% of total billed charges ,25.12,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,19.32,24,,,percent of total billed charges,24% of total billed charges ,19.32,24,,,percent of total billed charges,24% of total billed charges ,19.32,64.4,
ADMIN INFLUENZA VACCINE,2330507,CDM,771,RC,G0008,HCPCS,Outpatient,,,65,32.5,,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,52,80,,,percent of total billed charges,80% of total billed charges ,15.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,15.6,24,,,percent of total billed charges,24% of total billed charges ,20.28,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,52,
PNEUMOCOCCAL VACCINE ADMINISTRATION,2330508,CDM,771,RC,G0009,HCPCS,Outpatient,,,92.5,46.25,,24.85,26.86,,,percent of total billed charges,26.86% of total billed charges,69.38,75,,,percent of total billed charges,75% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,22.2,24,,,percent of total billed charges,24% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,74,80,,,percent of total billed charges,80% of total billed charges ,22.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,46.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,22.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.85,26.86,,,percent of total billed charges,26.86% of total billed charges,22.2,24,,,percent of total billed charges,24% of total billed charges ,28.86,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,22.2,24,,,percent of total billed charges,24% of total billed charges ,22.2,24,,,percent of total billed charges,24% of total billed charges ,22.2,74,
VACCINE/RABIES,2330509,CDM,260,RC,90471,HCPCS,Outpatient,,,80.5,40.25,,21.62,26.86,,,percent of total billed charges,26.86% of total billed charges,60.38,75,,,percent of total billed charges,75% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,19.32,24,,,percent of total billed charges,24% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,64.4,80,,,percent of total billed charges,80% of total billed charges ,19.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,40.57,50.4,,,percent of total billed charges,50.4% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,19.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.62,26.86,,,percent of total billed charges,26.86% of total billed charges,19.32,24,,,percent of total billed charges,24% of total billed charges ,25.12,31.2,,,percent of total billed charges,31.2% of total billed charges,64.4,80,,,percent of total billed charges,80% of total billed charges,19.32,24,,,percent of total billed charges,24% of total billed charges ,19.32,24,,,percent of total billed charges,24% of total billed charges ,19.32,64.4,
SPLINTING/STRAPPING,2330510,CDM,450,RC,,,Outpatient,,,210,105,,56.41,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,50.4,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,168,80,,,percent of total billed charges,80% of total billed charges ,50.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,105.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,51.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,56.41,26.86,,,percent of total billed charges,26.86% of total billed charges,50.4,24,,,percent of total billed charges,24% of total billed charges ,65.52,31.2,,,percent of total billed charges,31.2% of total billed charges,168,80,,,percent of total billed charges,80% of total billed charges,50.4,24,,,percent of total billed charges,24% of total billed charges ,50.4,24,,,percent of total billed charges,24% of total billed charges ,50.4,710,
SIMPLE PROCEDURE ER,2330511,CDM,450,RC,,,Outpatient,,,244,122,,65.54,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,58.56,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,195.2,80,,,percent of total billed charges,80% of total billed charges ,59.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,122.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,59.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,65.54,26.86,,,percent of total billed charges,26.86% of total billed charges,58.56,24,,,percent of total billed charges,24% of total billed charges ,76.13,31.2,,,percent of total billed charges,31.2% of total billed charges,195.2,80,,,percent of total billed charges,80% of total billed charges,58.56,24,,,percent of total billed charges,24% of total billed charges ,58.56,24,,,percent of total billed charges,24% of total billed charges ,58.56,710,
INTERMEDIATE PROCEDURE,2330512,CDM,450,RC,,,Outpatient,,,752,376,,201.99,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,180.48,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,601.6,80,,,percent of total billed charges,80% of total billed charges ,182.28,24.24,,,percent of total billed charges,24.24% of total billed charges ,379.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,564,75,,,percent of total billed charges,75% of total billed charges ,184.09,24.48,,,percent of total billed charges,24.48% of total billed charges ,201.99,26.86,,,percent of total billed charges,26.86% of total billed charges,180.48,24,,,percent of total billed charges,24% of total billed charges ,234.62,31.2,,,percent of total billed charges,31.2% of total billed charges,601.6,80,,,percent of total billed charges,80% of total billed charges,180.48,24,,,percent of total billed charges,24% of total billed charges ,180.48,24,,,percent of total billed charges,24% of total billed charges ,180.48,710,
COMPLEX PROCEDURE,2330513,CDM,450,RC,,,Outpatient,,,1045.5,522.75,,280.82,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,250.92,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,836.4,80,,,percent of total billed charges,80% of total billed charges ,253.43,24.24,,,percent of total billed charges,24.24% of total billed charges ,526.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,784.13,75,,,percent of total billed charges,75% of total billed charges ,255.94,24.48,,,percent of total billed charges,24.48% of total billed charges ,280.82,26.86,,,percent of total billed charges,26.86% of total billed charges,250.92,24,,,percent of total billed charges,24% of total billed charges ,326.2,31.2,,,percent of total billed charges,31.2% of total billed charges,836.4,80,,,percent of total billed charges,80% of total billed charges,250.92,24,,,percent of total billed charges,24% of total billed charges ,250.92,24,,,percent of total billed charges,24% of total billed charges ,250.92,836.4,
CRITICAL CARE 30-74 MIN,2330514,CDM,450,RC,99291,HCPCS,Outpatient,,,2089,1044.5,,561.11,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,501.36,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,1671.2,80,,,percent of total billed charges,80% of total billed charges ,506.37,24.24,,,percent of total billed charges,24.24% of total billed charges ,1052.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,1566.75,75,,,percent of total billed charges,75% of total billed charges ,511.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,561.11,26.86,,,percent of total billed charges,26.86% of total billed charges,501.36,24,,,percent of total billed charges,24% of total billed charges ,651.77,31.2,,,percent of total billed charges,31.2% of total billed charges,1671.2,80,,,percent of total billed charges,80% of total billed charges,501.36,24,,,percent of total billed charges,24% of total billed charges ,501.36,24,,,percent of total billed charges,24% of total billed charges ,501.36,1671.2,
CRITICAL CARE EACH ADDTL 30 MIN,2330515,CDM,450,RC,99292,HCPCS,Outpatient,,,557,278.5,,149.61,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,133.68,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,445.6,80,,,percent of total billed charges,80% of total billed charges ,135.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,280.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,417.75,75,,,percent of total billed charges,75% of total billed charges ,136.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,149.61,26.86,,,percent of total billed charges,26.86% of total billed charges,133.68,24,,,percent of total billed charges,24% of total billed charges ,173.78,31.2,,,percent of total billed charges,31.2% of total billed charges,445.6,80,,,percent of total billed charges,80% of total billed charges,133.68,24,,,percent of total billed charges,24% of total billed charges ,133.68,24,,,percent of total billed charges,24% of total billed charges ,133.68,710,
FOLEY CATH INSERTION,2330516,CDM,450,RC,51702,HCPCS,Outpatient,,,196.5,98.25,,52.78,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,47.16,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,157.2,80,,,percent of total billed charges,80% of total billed charges ,47.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,99.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,147.38,75,,,percent of total billed charges,75% of total billed charges ,48.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,52.78,26.86,,,percent of total billed charges,26.86% of total billed charges,47.16,24,,,percent of total billed charges,24% of total billed charges ,61.31,31.2,,,percent of total billed charges,31.2% of total billed charges,157.2,80,,,percent of total billed charges,80% of total billed charges,47.16,24,,,percent of total billed charges,24% of total billed charges ,47.16,24,,,percent of total billed charges,24% of total billed charges ,47.16,710,
INTUBATION BY PHYSICIAN,2330517,CDM,450,RC,31500,HCPCS,Outpatient,,,489.5,244.75,,131.48,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,117.48,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,391.6,80,,,percent of total billed charges,80% of total billed charges ,118.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,246.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,367.13,75,,,percent of total billed charges,75% of total billed charges ,119.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,131.48,26.86,,,percent of total billed charges,26.86% of total billed charges,117.48,24,,,percent of total billed charges,24% of total billed charges ,152.72,31.2,,,percent of total billed charges,31.2% of total billed charges,391.6,80,,,percent of total billed charges,80% of total billed charges,117.48,24,,,percent of total billed charges,24% of total billed charges ,117.48,24,,,percent of total billed charges,24% of total billed charges ,117.48,710,
EXTERNAL PACEMAKER,2330518,CDM,482,RC,92953,HCPCS,Outpatient,,,557,278.5,,149.61,26.86,,,percent of total billed charges,26.86% of total billed charges,417.75,75,,,percent of total billed charges,75% of total billed charges ,417.75,75,,,percent of total billed charges,75% of total billed charges ,133.68,24,,,percent of total billed charges,24% of total billed charges ,417.75,75,,,percent of total billed charges,75% of total billed charges ,417.75,75,,,percent of total billed charges,75% of total billed charges ,445.6,80,,,percent of total billed charges,80% of total billed charges ,135.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,280.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,417.75,75,,,percent of total billed charges,75% of total billed charges ,136.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,149.61,26.86,,,percent of total billed charges,26.86% of total billed charges,133.68,24,,,percent of total billed charges,24% of total billed charges ,173.78,31.2,,,percent of total billed charges,31.2% of total billed charges,445.6,80,,,percent of total billed charges,80% of total billed charges,133.68,24,,,percent of total billed charges,24% of total billed charges ,133.68,24,,,percent of total billed charges,24% of total billed charges ,133.68,445.6,
PARACENTESIS,2330519,CDM,450,RC,49082,HCPCS,Outpatient,,,501.5,250.75,,134.7,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,120.36,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,401.2,80,,,percent of total billed charges,80% of total billed charges ,121.56,24.24,,,percent of total billed charges,24.24% of total billed charges ,252.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,376.13,75,,,percent of total billed charges,75% of total billed charges ,122.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,134.7,26.86,,,percent of total billed charges,26.86% of total billed charges,120.36,24,,,percent of total billed charges,24% of total billed charges ,156.47,31.2,,,percent of total billed charges,31.2% of total billed charges,401.2,80,,,percent of total billed charges,80% of total billed charges,120.36,24,,,percent of total billed charges,24% of total billed charges ,120.36,24,,,percent of total billed charges,24% of total billed charges ,120.36,710,
SPINAL TAP,2330520,CDM,450,RC,62272,HCPCS,Outpatient,,,557,278.5,,149.61,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,133.68,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,445.6,80,,,percent of total billed charges,80% of total billed charges ,135.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,280.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,417.75,75,,,percent of total billed charges,75% of total billed charges ,136.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,149.61,26.86,,,percent of total billed charges,26.86% of total billed charges,133.68,24,,,percent of total billed charges,24% of total billed charges ,173.78,31.2,,,percent of total billed charges,31.2% of total billed charges,445.6,80,,,percent of total billed charges,80% of total billed charges,133.68,24,,,percent of total billed charges,24% of total billed charges ,133.68,24,,,percent of total billed charges,24% of total billed charges ,133.68,710,
THORACENTESIS FOR ASPIRATION,2330521,CDM,450,RC,32555,HCPCS,Outpatient,,,529.5,264.75,,142.22,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,127.08,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,423.6,80,,,percent of total billed charges,80% of total billed charges ,128.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,266.87,50.4,,,percent of total billed charges,50.4% of total billed charges ,397.13,75,,,percent of total billed charges,75% of total billed charges ,129.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,142.22,26.86,,,percent of total billed charges,26.86% of total billed charges,127.08,24,,,percent of total billed charges,24% of total billed charges ,165.2,31.2,,,percent of total billed charges,31.2% of total billed charges,423.6,80,,,percent of total billed charges,80% of total billed charges,127.08,24,,,percent of total billed charges,24% of total billed charges ,127.08,24,,,percent of total billed charges,24% of total billed charges ,127.08,710,
THORACENTESIS W/WATER SEAL,2330522,CDM,450,RC,32556,HCPCS,Outpatient,,,557,278.5,,149.61,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,133.68,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,445.6,80,,,percent of total billed charges,80% of total billed charges ,135.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,280.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,417.75,75,,,percent of total billed charges,75% of total billed charges ,136.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,149.61,26.86,,,percent of total billed charges,26.86% of total billed charges,133.68,24,,,percent of total billed charges,24% of total billed charges ,173.78,31.2,,,percent of total billed charges,31.2% of total billed charges,445.6,80,,,percent of total billed charges,80% of total billed charges,133.68,24,,,percent of total billed charges,24% of total billed charges ,133.68,24,,,percent of total billed charges,24% of total billed charges ,133.68,710,
IM/SQ INJECTION,2330523,CDM,260,RC,96372,HCPCS,Outpatient,,,157.5,78.75,,42.3,26.86,,,percent of total billed charges,26.86% of total billed charges,118.13,75,,,percent of total billed charges,75% of total billed charges ,118.13,75,,,percent of total billed charges,75% of total billed charges ,37.8,24,,,percent of total billed charges,24% of total billed charges ,118.13,75,,,percent of total billed charges,75% of total billed charges ,118.13,75,,,percent of total billed charges,75% of total billed charges ,126,80,,,percent of total billed charges,80% of total billed charges ,38.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,79.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,118.13,75,,,percent of total billed charges,75% of total billed charges ,38.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,42.3,26.86,,,percent of total billed charges,26.86% of total billed charges,37.8,24,,,percent of total billed charges,24% of total billed charges ,49.14,31.2,,,percent of total billed charges,31.2% of total billed charges,126,80,,,percent of total billed charges,80% of total billed charges,37.8,24,,,percent of total billed charges,24% of total billed charges ,37.8,24,,,percent of total billed charges,24% of total billed charges ,37.8,126,
IM INJECTION,2330524,CDM,260,RC,96372,HCPCS,Outpatient,,,157.5,78.75,,42.3,26.86,,,percent of total billed charges,26.86% of total billed charges,118.13,75,,,percent of total billed charges,75% of total billed charges ,118.13,75,,,percent of total billed charges,75% of total billed charges ,37.8,24,,,percent of total billed charges,24% of total billed charges ,118.13,75,,,percent of total billed charges,75% of total billed charges ,118.13,75,,,percent of total billed charges,75% of total billed charges ,126,80,,,percent of total billed charges,80% of total billed charges ,38.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,79.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,118.13,75,,,percent of total billed charges,75% of total billed charges ,38.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,42.3,26.86,,,percent of total billed charges,26.86% of total billed charges,37.8,24,,,percent of total billed charges,24% of total billed charges ,49.14,31.2,,,percent of total billed charges,31.2% of total billed charges,126,80,,,percent of total billed charges,80% of total billed charges,37.8,24,,,percent of total billed charges,24% of total billed charges ,37.8,24,,,percent of total billed charges,24% of total billed charges ,37.8,126,
IV PUSH INIT DRUG,2330525,CDM,260,RC,96374,HCPCS,Outpatient,,,245,122.5,,65.81,26.86,,,percent of total billed charges,26.86% of total billed charges,183.75,75,,,percent of total billed charges,75% of total billed charges ,183.75,75,,,percent of total billed charges,75% of total billed charges ,58.8,24,,,percent of total billed charges,24% of total billed charges ,183.75,75,,,percent of total billed charges,75% of total billed charges ,183.75,75,,,percent of total billed charges,75% of total billed charges ,196,80,,,percent of total billed charges,80% of total billed charges ,59.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,123.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,183.75,75,,,percent of total billed charges,75% of total billed charges ,59.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,65.81,26.86,,,percent of total billed charges,26.86% of total billed charges,58.8,24,,,percent of total billed charges,24% of total billed charges ,76.44,31.2,,,percent of total billed charges,31.2% of total billed charges,196,80,,,percent of total billed charges,80% of total billed charges,58.8,24,,,percent of total billed charges,24% of total billed charges ,58.8,24,,,percent of total billed charges,24% of total billed charges ,58.8,196,
IV PUSH EA ADD NEWRX,2330526,CDM,260,RC,96375,HCPCS,Outpatient,,,141,70.5,,37.87,26.86,,,percent of total billed charges,26.86% of total billed charges,105.75,75,,,percent of total billed charges,75% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,112.8,80,,,percent of total billed charges,80% of total billed charges ,34.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,71.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,34.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.87,26.86,,,percent of total billed charges,26.86% of total billed charges,33.84,24,,,percent of total billed charges,24% of total billed charges ,43.99,31.2,,,percent of total billed charges,31.2% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,33.84,24,,,percent of total billed charges,24% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,33.84,112.8,
IV PUSH EACH ADDTL SAME DRUG,2330527,CDM,260,RC,96376,HCPCS,Outpatient,,,210,105,,56.41,26.86,,,percent of total billed charges,26.86% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,50.4,24,,,percent of total billed charges,24% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,168,80,,,percent of total billed charges,80% of total billed charges ,50.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,105.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,51.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,56.41,26.86,,,percent of total billed charges,26.86% of total billed charges,50.4,24,,,percent of total billed charges,24% of total billed charges ,65.52,31.2,,,percent of total billed charges,31.2% of total billed charges,168,80,,,percent of total billed charges,80% of total billed charges,50.4,24,,,percent of total billed charges,24% of total billed charges ,50.4,24,,,percent of total billed charges,24% of total billed charges ,50.4,168,
IV INFUSION INT,2330528,CDM,260,RC,96365,HCPCS,Outpatient,,,501.5,250.75,,134.7,26.86,,,percent of total billed charges,26.86% of total billed charges,376.13,75,,,percent of total billed charges,75% of total billed charges ,376.13,75,,,percent of total billed charges,75% of total billed charges ,120.36,24,,,percent of total billed charges,24% of total billed charges ,376.13,75,,,percent of total billed charges,75% of total billed charges ,376.13,75,,,percent of total billed charges,75% of total billed charges ,401.2,80,,,percent of total billed charges,80% of total billed charges ,121.56,24.24,,,percent of total billed charges,24.24% of total billed charges ,252.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,376.13,75,,,percent of total billed charges,75% of total billed charges ,122.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,134.7,26.86,,,percent of total billed charges,26.86% of total billed charges,120.36,24,,,percent of total billed charges,24% of total billed charges ,156.47,31.2,,,percent of total billed charges,31.2% of total billed charges,401.2,80,,,percent of total billed charges,80% of total billed charges,120.36,24,,,percent of total billed charges,24% of total billed charges ,120.36,24,,,percent of total billed charges,24% of total billed charges ,120.36,401.2,
IV INFUSION EA ADDITIONAL HOUR,2330529,CDM,260,RC,96366,HCPCS,Outpatient,,,235,117.5,,63.12,26.86,,,percent of total billed charges,26.86% of total billed charges,176.25,75,,,percent of total billed charges,75% of total billed charges ,176.25,75,,,percent of total billed charges,75% of total billed charges ,56.4,24,,,percent of total billed charges,24% of total billed charges ,176.25,75,,,percent of total billed charges,75% of total billed charges ,176.25,75,,,percent of total billed charges,75% of total billed charges ,188,80,,,percent of total billed charges,80% of total billed charges ,56.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,118.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,176.25,75,,,percent of total billed charges,75% of total billed charges ,57.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.12,26.86,,,percent of total billed charges,26.86% of total billed charges,56.4,24,,,percent of total billed charges,24% of total billed charges ,73.32,31.2,,,percent of total billed charges,31.2% of total billed charges,188,80,,,percent of total billed charges,80% of total billed charges,56.4,24,,,percent of total billed charges,24% of total billed charges ,56.4,24,,,percent of total billed charges,24% of total billed charges ,56.4,188,
IV INFUSION EA ADDTL SEQUENTIAL HR,2330530,CDM,260,RC,96367,HCPCS,Outpatient,,,143,71.5,,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,114.4,80,,,percent of total billed charges,80% of total billed charges ,34.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,35.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,44.62,31.2,,,percent of total billed charges,31.2% of total billed charges,114.4,80,,,percent of total billed charges,80% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,114.4,
IV CONCURRENT INFUSION,2330531,CDM,260,RC,96368,HCPCS,Outpatient,,,234,117,,62.85,26.86,,,percent of total billed charges,26.86% of total billed charges,175.5,75,,,percent of total billed charges,75% of total billed charges ,175.5,75,,,percent of total billed charges,75% of total billed charges ,56.16,24,,,percent of total billed charges,24% of total billed charges ,175.5,75,,,percent of total billed charges,75% of total billed charges ,175.5,75,,,percent of total billed charges,75% of total billed charges ,187.2,80,,,percent of total billed charges,80% of total billed charges ,56.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,117.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,175.5,75,,,percent of total billed charges,75% of total billed charges ,57.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,62.85,26.86,,,percent of total billed charges,26.86% of total billed charges,56.16,24,,,percent of total billed charges,24% of total billed charges ,73.01,31.2,,,percent of total billed charges,31.2% of total billed charges,187.2,80,,,percent of total billed charges,80% of total billed charges,56.16,24,,,percent of total billed charges,24% of total billed charges ,56.16,24,,,percent of total billed charges,24% of total billed charges ,56.16,187.2,
IV HYDRATION INT HOU,2330532,CDM,260,RC,96360,HCPCS,Outpatient,,,281,140.5,,75.48,26.86,,,percent of total billed charges,26.86% of total billed charges,210.75,75,,,percent of total billed charges,75% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,67.44,24,,,percent of total billed charges,24% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,224.8,80,,,percent of total billed charges,80% of total billed charges ,68.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,141.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,68.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,75.48,26.86,,,percent of total billed charges,26.86% of total billed charges,67.44,24,,,percent of total billed charges,24% of total billed charges ,87.67,31.2,,,percent of total billed charges,31.2% of total billed charges,224.8,80,,,percent of total billed charges,80% of total billed charges,67.44,24,,,percent of total billed charges,24% of total billed charges ,67.44,24,,,percent of total billed charges,24% of total billed charges ,67.44,224.8,
HYDRATION EA ADDITIONAL HR,2330533,CDM,260,RC,96361,HCPCS,Outpatient,,,171,85.5,,45.93,26.86,,,percent of total billed charges,26.86% of total billed charges,128.25,75,,,percent of total billed charges,75% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,41.04,24,,,percent of total billed charges,24% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,136.8,80,,,percent of total billed charges,80% of total billed charges ,41.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,86.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,41.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,45.93,26.86,,,percent of total billed charges,26.86% of total billed charges,41.04,24,,,percent of total billed charges,24% of total billed charges ,53.35,31.2,,,percent of total billed charges,31.2% of total billed charges,136.8,80,,,percent of total billed charges,80% of total billed charges,41.04,24,,,percent of total billed charges,24% of total billed charges ,41.04,24,,,percent of total billed charges,24% of total billed charges ,41.04,136.8,
CHEMOTHERAPY INITIAL HOUR,2330534,CDM,260,RC,96413,HCPCS,Outpatient,,,501.5,250.75,,134.7,26.86,,,percent of total billed charges,26.86% of total billed charges,376.13,75,,,percent of total billed charges,75% of total billed charges ,376.13,75,,,percent of total billed charges,75% of total billed charges ,120.36,24,,,percent of total billed charges,24% of total billed charges ,376.13,75,,,percent of total billed charges,75% of total billed charges ,376.13,75,,,percent of total billed charges,75% of total billed charges ,401.2,80,,,percent of total billed charges,80% of total billed charges ,121.56,24.24,,,percent of total billed charges,24.24% of total billed charges ,252.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,376.13,75,,,percent of total billed charges,75% of total billed charges ,122.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,134.7,26.86,,,percent of total billed charges,26.86% of total billed charges,120.36,24,,,percent of total billed charges,24% of total billed charges ,156.47,31.2,,,percent of total billed charges,31.2% of total billed charges,401.2,80,,,percent of total billed charges,80% of total billed charges,120.36,24,,,percent of total billed charges,24% of total billed charges ,120.36,24,,,percent of total billed charges,24% of total billed charges ,120.36,401.2,
CHEMOTHERAPY EA ADDITIONAL HOUR,2330535,CDM,260,RC,96415,HCPCS,Outpatient,,,235,117.5,,63.12,26.86,,,percent of total billed charges,26.86% of total billed charges,176.25,75,,,percent of total billed charges,75% of total billed charges ,176.25,75,,,percent of total billed charges,75% of total billed charges ,56.4,24,,,percent of total billed charges,24% of total billed charges ,176.25,75,,,percent of total billed charges,75% of total billed charges ,176.25,75,,,percent of total billed charges,75% of total billed charges ,188,80,,,percent of total billed charges,80% of total billed charges ,56.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,118.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,176.25,75,,,percent of total billed charges,75% of total billed charges ,57.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.12,26.86,,,percent of total billed charges,26.86% of total billed charges,56.4,24,,,percent of total billed charges,24% of total billed charges ,73.32,31.2,,,percent of total billed charges,31.2% of total billed charges,188,80,,,percent of total billed charges,80% of total billed charges,56.4,24,,,percent of total billed charges,24% of total billed charges ,56.4,24,,,percent of total billed charges,24% of total billed charges ,56.4,188,
I&D ABSCESS SIMPLE,2330540,CDM,450,RC,10060,HCPCS,Outpatient,,,717,358.5,,192.59,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,172.08,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,573.6,80,,,percent of total billed charges,80% of total billed charges ,173.8,24.24,,,percent of total billed charges,24.24% of total billed charges ,361.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,537.75,75,,,percent of total billed charges,75% of total billed charges ,175.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,192.59,26.86,,,percent of total billed charges,26.86% of total billed charges,172.08,24,,,percent of total billed charges,24% of total billed charges ,223.7,31.2,,,percent of total billed charges,31.2% of total billed charges,573.6,80,,,percent of total billed charges,80% of total billed charges,172.08,24,,,percent of total billed charges,24% of total billed charges ,172.08,24,,,percent of total billed charges,24% of total billed charges ,172.08,710,
I&D ABSCESS MULTIPLE COMPLICATED,2330541,CDM,450,RC,10061,HCPCS,Outpatient,,,1318.5,659.25,,354.15,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,316.44,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,1054.8,80,,,percent of total billed charges,80% of total billed charges ,319.6,24.24,,,percent of total billed charges,24.24% of total billed charges ,664.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,988.88,75,,,percent of total billed charges,75% of total billed charges ,322.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,354.15,26.86,,,percent of total billed charges,26.86% of total billed charges,316.44,24,,,percent of total billed charges,24% of total billed charges ,411.37,31.2,,,percent of total billed charges,31.2% of total billed charges,1054.8,80,,,percent of total billed charges,80% of total billed charges,316.44,24,,,percent of total billed charges,24% of total billed charges ,316.44,24,,,percent of total billed charges,24% of total billed charges ,316.44,1054.8,
I&D PILONIDAL CYST,2330542,CDM,450,RC,10080,HCPCS,Outpatient,,,2431,1215.5,,652.97,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,583.44,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,1944.8,80,,,percent of total billed charges,80% of total billed charges ,589.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,1225.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,1823.25,75,,,percent of total billed charges,75% of total billed charges ,595.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,652.97,26.86,,,percent of total billed charges,26.86% of total billed charges,583.44,24,,,percent of total billed charges,24% of total billed charges ,758.47,31.2,,,percent of total billed charges,31.2% of total billed charges,1944.8,80,,,percent of total billed charges,80% of total billed charges,583.44,24,,,percent of total billed charges,24% of total billed charges ,583.44,24,,,percent of total billed charges,24% of total billed charges ,583.44,1944.8,
I&D FOREIGN BODY SUBQ SIMPLE,2330543,CDM,450,RC,10120,HCPCS,Outpatient,,,1318.5,659.25,,354.15,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,316.44,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,1054.8,80,,,percent of total billed charges,80% of total billed charges ,319.6,24.24,,,percent of total billed charges,24.24% of total billed charges ,664.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,988.88,75,,,percent of total billed charges,75% of total billed charges ,322.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,354.15,26.86,,,percent of total billed charges,26.86% of total billed charges,316.44,24,,,percent of total billed charges,24% of total billed charges ,411.37,31.2,,,percent of total billed charges,31.2% of total billed charges,1054.8,80,,,percent of total billed charges,80% of total billed charges,316.44,24,,,percent of total billed charges,24% of total billed charges ,316.44,24,,,percent of total billed charges,24% of total billed charges ,316.44,1054.8,
I&D HEMATOMA/FLUID,2330544,CDM,450,RC,10140,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
PUNCTURE ASPIRATION HEMATOMA,2330545,CDM,450,RC,10160,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
AVULSION NAIL PLATE,2330546,CDM,450,RC,11730,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
DRAIN BLOOD FROM UNDER NAIL,2330547,CDM,450,RC,11740,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
REMOVAL NAIL BED,2330548,CDM,450,RC,11750,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR S/N/AX/GEN/TRK <2.5 CM,2330549,CDM,450,RC,12001,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR LAC 2.5CM TONGUE,2330550,CDM,450,RC,41250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
COLLECT BLOOD FROM PICC,2330552,CDM,450,RC,36592,HCPCS,Outpatient,,,446,223,,119.8,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,107.04,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,356.8,80,,,percent of total billed charges,80% of total billed charges ,108.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,224.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,334.5,75,,,percent of total billed charges,75% of total billed charges ,109.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,119.8,26.86,,,percent of total billed charges,26.86% of total billed charges,107.04,24,,,percent of total billed charges,24% of total billed charges ,139.15,31.2,,,percent of total billed charges,31.2% of total billed charges,356.8,80,,,percent of total billed charges,80% of total billed charges,107.04,24,,,percent of total billed charges,24% of total billed charges ,107.04,24,,,percent of total billed charges,24% of total billed charges ,107.04,710,
REM FB PHARYNX,2330553,CDM,450,RC,42809,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
NG TUBE PLACEMENT,2330554,CDM,450,RC,43752,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
INCISION EXT HEMORROID,2330555,CDM,450,RC,46083,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
INCISION RECTAL ABCESS,2330556,CDM,450,RC,46040,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
SPINE/BRAIN PUMP REFILL & MNTC,2330557,CDM,450,RC,95990,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
ABD PARACENTESIS W/O IMAGING,2330558,CDM,450,RC,49082,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
THROMBOLYSIS,2330559,CDM,450,RC,92977,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
SPINAL BRINA PUMP REFILL,2330560,CDM,450,RC,95991,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CARDIOPULMONARY RESUSCITATION,2330561,CDM,450,RC,92950,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CYSTOSTOMY TUBE CHANGE,2330562,CDM,450,RC,51705,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CYSTO W/STONE REM SIMPLE,2330563,CDM,450,RC,52310,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
I&D BARHOLINS GLAND ABSCESS,2330564,CDM,450,RC,56420,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
FETAL NON STRESS,2330565,CDM,450,RC,59025,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
VAGINAL DELIVERY,2330566,CDM,450,RC,59409,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
LUMBAR PUNCTURE,2330567,CDM,450,RC,62270,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
DRN CEREBRO SPINAL FLUID,2330568,CDM,450,RC,62272,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
NERVE BLOCK FACIAL,2330569,CDM,450,RC,64999,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
THER/PROPH INJ INTRA ARTERIAL,2330570,CDM,450,RC,96373,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
DRAIN EXT EAR LESION,2330571,CDM,450,RC,69000,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CLEAR OUTER EAR CANAL,2330572,CDM,450,RC,69200,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
REMOVAL IMPACTED EAR WAX,2330573,CDM,450,RC,69209,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
REM EARWAX W INSTRUMENT,2330574,CDM,450,RC,69210,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
APPLU ON BODY INJECTOR,2330575,CDM,450,RC,96377,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
DEBRIDE OPEN WOUND < 20CM,2330576,CDM,450,RC,97597,HCPCS,Outpatient,,,717,358.5,,192.59,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,172.08,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,573.6,80,,,percent of total billed charges,80% of total billed charges ,173.8,24.24,,,percent of total billed charges,24.24% of total billed charges ,361.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,537.75,75,,,percent of total billed charges,75% of total billed charges ,175.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,192.59,26.86,,,percent of total billed charges,26.86% of total billed charges,172.08,24,,,percent of total billed charges,24% of total billed charges ,223.7,31.2,,,percent of total billed charges,31.2% of total billed charges,573.6,80,,,percent of total billed charges,80% of total billed charges,172.08,24,,,percent of total billed charges,24% of total billed charges ,172.08,24,,,percent of total billed charges,24% of total billed charges ,172.08,710,
CRITICAL CARE > 74 MIN,2330577,CDM,450,RC,99292,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
REMOVAL IMPACTED EAR WAX BILAT,2330578,CDM,450,RC,69209,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
REMOVE EAR WAX BILAT W INSTRUMENT,2330579,CDM,450,RC,69210,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR S/N/AX/GEN/TRK 2.6-7.5CM,2330590,CDM,450,RC,12002,HCPCS,Outpatient,,,717,358.5,,192.59,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,172.08,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,573.6,80,,,percent of total billed charges,80% of total billed charges ,173.8,24.24,,,percent of total billed charges,24.24% of total billed charges ,361.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,537.75,75,,,percent of total billed charges,75% of total billed charges ,175.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,192.59,26.86,,,percent of total billed charges,26.86% of total billed charges,172.08,24,,,percent of total billed charges,24% of total billed charges ,223.7,31.2,,,percent of total billed charges,31.2% of total billed charges,573.6,80,,,percent of total billed charges,80% of total billed charges,172.08,24,,,percent of total billed charges,24% of total billed charges ,172.08,24,,,percent of total billed charges,24% of total billed charges ,172.08,710,
RPR S/N/A/GEN/TRK 12.6-20CM,2330592,CDM,450,RC,12005,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR S/N/A/GEN/TRK 20.1 - 30CM,2330593,CDM,450,RC,12006,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
"RPR SIMPLE F/E/E/N/L/, <2.5 CM",2330594,CDM,450,RC,12011,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR SIMPLE F/E/E/N/L/M 2.6-5CM,2330595,CDM,450,RC,12013,HCPCS,Outpatient,,,717,358.5,,192.59,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,172.08,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,573.6,80,,,percent of total billed charges,80% of total billed charges ,173.8,24.24,,,percent of total billed charges,24.24% of total billed charges ,361.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,537.75,75,,,percent of total billed charges,75% of total billed charges ,175.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,192.59,26.86,,,percent of total billed charges,26.86% of total billed charges,172.08,24,,,percent of total billed charges,24% of total billed charges ,223.7,31.2,,,percent of total billed charges,31.2% of total billed charges,573.6,80,,,percent of total billed charges,80% of total billed charges,172.08,24,,,percent of total billed charges,24% of total billed charges ,172.08,24,,,percent of total billed charges,24% of total billed charges ,172.08,710,
"RPR SIMPLE F/E/E/N/L/, 5.1-7.5CM",2330596,CDM,450,RC,12014,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR SIMPLE F/E/E/N/L/M 7.6-12.5CM,2330597,CDM,450,RC,12015,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CLOSURE SPLIT WOUND,2330598,CDM,450,RC,12020,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER S/A/T/E 2.6-7.5CM,2330599,CDM,450,RC,12032,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER N/H/F/XTRNL 2.6-7.5CM,2330600,CDM,450,RC,12042,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER N/H/F/XTML 7.6-12.5CM,2330601,CDM,450,RC,12044,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR CMPLX SCALP/ARM/LEG 2.6-7.5CM,2330602,CDM,450,RC,13121,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR CMPLX F/C/C/M/N/AX/G/H/F 1.1-2.5CM,2330603,CDM,450,RC,13131,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR CMPLX EYELID/NOSE/EAR LIP 2.6-7.5CM,2330604,CDM,450,RC,13152,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
BURN CARE PART THICK SMALL,2330605,CDM,450,RC,16020,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
BURN CARE PART THICK LARGE,2330606,CDM,450,RC,16030,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
EXPLORE WOUND EXTREMITY,2330607,CDM,450,RC,20103,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
ARTHROCENTESIS JOINT BURSA W/O US,2330608,CDM,450,RC,20605,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
ARTHOCENTESIS JOINT BURSA MAJOR,2330609,CDM,450,RC,20610,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
ASPIRATION & INJ GANGLION CYST,2330610,CDM,450,RC,20612,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TRT SHOULDER DISLOCATION,2330611,CDM,450,RC,23650,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
SHOULDER DISLOC W MANIP,2330612,CDM,450,RC,23655,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX ELBOW DISLOC W/O ANESTHESIA,2330613,CDM,450,RC,24600,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX NURSEMAID ELBOW IN CHILDW/MANIP,2330614,CDM,450,RC,24640,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX DISTAL RADIAL FX W/MANIP,2330615,CDM,450,RC,25605,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TREAT FINGER DISLOCATION,2330616,CDM,450,RC,26770,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
FINGER DISLOC REQ ANESTH,2330617,CDM,450,RC,26775,HCPCS,Outpatient,,,1006.5,503.25,,270.35,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,241.56,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,805.2,80,,,percent of total billed charges,80% of total billed charges ,243.98,24.24,,,percent of total billed charges,24.24% of total billed charges ,507.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,754.88,75,,,percent of total billed charges,75% of total billed charges ,246.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,270.35,26.86,,,percent of total billed charges,26.86% of total billed charges,241.56,24,,,percent of total billed charges,24% of total billed charges ,314.03,31.2,,,percent of total billed charges,31.2% of total billed charges,805.2,80,,,percent of total billed charges,80% of total billed charges,241.56,24,,,percent of total billed charges,24% of total billed charges ,241.56,24,,,percent of total billed charges,24% of total billed charges ,241.56,805.2,
PATELLER DISLOC W/ANESTH,2330618,CDM,450,RC,27562,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CAST SHORT ARM,2330619,CDM,450,RC,29075,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
SPLINT LONG ARM,2330620,CDM,450,RC,29105,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
SPLINT SHORT ARM,2330621,CDM,450,RC,29125,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
FINGER SPLINT APPLICATION,2330622,CDM,450,RC,29130,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
SHOULDER STRAPPING,2330623,CDM,450,RC,29240,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
SPLINT LONG LEG,2330624,CDM,450,RC,29505,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
SPLINT SHORT LEG,2330625,CDM,450,RC,29515,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CONTROL OF NOSEBLEED,2330626,CDM,450,RC,30901,HCPCS,Outpatient,,,475,237.5,,127.59,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,114,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,380,80,,,percent of total billed charges,80% of total billed charges ,115.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,239.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,356.25,75,,,percent of total billed charges,75% of total billed charges ,116.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,127.59,26.86,,,percent of total billed charges,26.86% of total billed charges,114,24,,,percent of total billed charges,24% of total billed charges ,148.2,31.2,,,percent of total billed charges,31.2% of total billed charges,380,80,,,percent of total billed charges,80% of total billed charges,114,24,,,percent of total billed charges,24% of total billed charges ,114,24,,,percent of total billed charges,24% of total billed charges ,114,710,
NASAL HEMORRHAGE ANTERIOR COMPLEX,2330627,CDM,450,RC,30903,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
NASAL HEMORRHAGE PACKS AND CAUTERY,2330628,CDM,450,RC,30905,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CHEST TUBE INSERTION,2330629,CDM,450,RC,32551,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
THORACENTESIS W/O IMAGING,2330630,CDM,450,RC,32554,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR BLOOD VESSEL LESION,2330631,CDM,450,RC,35226,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
BLOOD TRANSFUSION SERVICE,2330632,CDM,450,RC,36430,HCPCS,Outpatient,,,1128,564,,302.98,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,270.72,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,902.4,80,,,percent of total billed charges,80% of total billed charges ,273.43,24.24,,,percent of total billed charges,24.24% of total billed charges ,568.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,846,75,,,percent of total billed charges,75% of total billed charges ,276.13,24.48,,,percent of total billed charges,24.48% of total billed charges ,302.98,26.86,,,percent of total billed charges,26.86% of total billed charges,270.72,24,,,percent of total billed charges,24% of total billed charges ,351.94,31.2,,,percent of total billed charges,31.2% of total billed charges,902.4,80,,,percent of total billed charges,80% of total billed charges,270.72,24,,,percent of total billed charges,24% of total billed charges ,270.72,24,,,percent of total billed charges,24% of total billed charges ,270.72,902.4,
PICC LINE INSERTION,2330633,CDM,450,RC,36569,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
ULTRASOUND GUIDANCE FOR VASCULAR ACCESS,2330634,CDM,450,RC,76937,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
REMOVE FOREIGN BODY SUBQ COMPLEX,2330635,CDM,450,RC,10121,HCPCS,Outpatient,,,1318.5,659.25,,354.15,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,316.44,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,1054.8,80,,,percent of total billed charges,80% of total billed charges ,319.6,24.24,,,percent of total billed charges,24.24% of total billed charges ,664.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,988.88,75,,,percent of total billed charges,75% of total billed charges ,322.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,354.15,26.86,,,percent of total billed charges,26.86% of total billed charges,316.44,24,,,percent of total billed charges,24% of total billed charges ,411.37,31.2,,,percent of total billed charges,31.2% of total billed charges,1054.8,80,,,percent of total billed charges,80% of total billed charges,316.44,24,,,percent of total billed charges,24% of total billed charges ,316.44,24,,,percent of total billed charges,24% of total billed charges ,316.44,1054.8,
DEBRIDEMENT SUBCU FIRST 20CM OR LESS,2330636,CDM,450,RC,11042,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
DEBRIDEMENT MUSCLE FIRST 20CM OR LESS,2330637,CDM,450,RC,11043,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
DEBRIDEMENT BONE FIRST 20CM OR LESS,2330638,CDM,450,RC,11044,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
DEBRIDEMENT SQ ADD'L 20CM,2330639,CDM,450,RC,11045,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
DEBRIDEMENT MUSCLE ADD'L 20CM,2330640,CDM,450,RC,11046,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
DEBRIDEMENT BONE ADDITIONAL 20CM,2330641,CDM,450,RC,11047,HCPCS,Outpatient,,,370,185,,99.38,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,88.8,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,296,80,,,percent of total billed charges,80% of total billed charges ,89.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,186.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,277.5,75,,,percent of total billed charges,75% of total billed charges ,90.58,24.48,,,percent of total billed charges,24.48% of total billed charges ,99.38,26.86,,,percent of total billed charges,26.86% of total billed charges,88.8,24,,,percent of total billed charges,24% of total billed charges ,115.44,31.2,,,percent of total billed charges,31.2% of total billed charges,296,80,,,percent of total billed charges,80% of total billed charges,88.8,24,,,percent of total billed charges,24% of total billed charges ,88.8,24,,,percent of total billed charges,24% of total billed charges ,88.8,710,
"DEBRIDEMENT OF NAIL(S), ANY METHOD; 1-5",2330642,CDM,450,RC,11720,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
AVULSION OF NAIL PLATE - EA  ADDITIONAL,2330643,CDM,450,RC,11732,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
REPAIR NAIL BED,2330644,CDM,450,RC,11760,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR SIMPLE S/N/A/GEN/TRK/EX >30,2330645,CDM,450,RC,12007,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR SIMPLE LAC F/E/E/N/L 12.6-20CM,2330646,CDM,450,RC,12016,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR SIMPLE LAC F/E/E/N/L 20.1-30CM,2330648,CDM,450,RC,12017,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR SIMPLE LAC F/E/E/N/L >30CM,2330649,CDM,450,RC,12018,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER S/A/T/E 2.5CM OR LESS,2330650,CDM,450,RC,12031,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER S/A/T/E 7.6-12.5CM,2330651,CDM,450,RC,12034,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER S/A/T/E 12.6-20CM,2330652,CDM,450,RC,12035,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER S/A/T/E 20.1-30CM,2330653,CDM,450,RC,12036,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER S/A/T/E >30CM,2330654,CDM,450,RC,12037,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER N/H/F/XTRNL 2.5CM OR LESS,2330655,CDM,450,RC,12041,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER N/H/F/XTML 12.6-20.0CM,2330656,CDM,450,RC,12045,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER N/H/F/XTML 20.1-30.0CM,2330657,CDM,450,RC,12046,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER N/H/F/XTML >30.0CM,2330658,CDM,450,RC,12047,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER F/E/E/N/L 2.5CM OR LESS,2330659,CDM,450,RC,12051,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER F/E/E/N/L 2.6-5.0CM,2330660,CDM,450,RC,12052,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER F/E/E/N/L 5.1-7.5CM,2330661,CDM,450,RC,12053,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER F/E/E/N/L 7.6-12.5CM,2330662,CDM,450,RC,12054,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER F/E/E/N/L 12.6-20.0CM,2330663,CDM,450,RC,12055,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER F/E/E/N/L 20.1-30.0CM,2330664,CDM,450,RC,12056,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER F/E/E/N/L >30.0CM,2330665,CDM,450,RC,12057,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER TRUNK 1.1-2.5CM,2330666,CDM,450,RC,13100,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER TRUNK 2.6-7.5CM,2330667,CDM,450,RC,13101,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR INTER TRUNK EA ADD'L 5CM OR LESS,2330668,CDM,450,RC,13102,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR CMPLX SCALP/ARM/LEG 1.1-2.5CM,2330669,CDM,450,RC,13120,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR CMPLX SCALP/ARM/LEG EA ADD'L 5CM/<,2330670,CDM,450,RC,13122,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR CMPLX F/C/C/M/N/AX/G/H/F 2.6-7.5CM,2330671,CDM,450,RC,13132,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR CMPLX F/C/C/M/N/AX/G/H/F ADDL 5CM/<,2330672,CDM,450,RC,13133,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR CMPLX EYELID/NOSE/EAR LIP 1.1-2.5CM,2330673,CDM,450,RC,13151,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR CMPLX EYELID/NOSE/EAR LIPADDL 5CM/<,2330674,CDM,450,RC,13153,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
BURN CARE PART THICK MEDIUM,2330675,CDM,450,RC,16025,HCPCS,Outpatient,,,478,239,,128.39,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,114.72,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,382.4,80,,,percent of total billed charges,80% of total billed charges ,115.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,240.91,50.4,,,percent of total billed charges,50.4% of total billed charges ,358.5,75,,,percent of total billed charges,75% of total billed charges ,117.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,128.39,26.86,,,percent of total billed charges,26.86% of total billed charges,114.72,24,,,percent of total billed charges,24% of total billed charges ,149.14,31.2,,,percent of total billed charges,31.2% of total billed charges,382.4,80,,,percent of total billed charges,80% of total billed charges,114.72,24,,,percent of total billed charges,24% of total billed charges ,114.72,24,,,percent of total billed charges,24% of total billed charges ,114.72,710,
INJECTION SINGLE TENDON ORIGIN/INSERTION,2330676,CDM,450,RC,20551,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
INJ TRIGGER POINT 1-2 MUSCLES,2330677,CDM,450,RC,20552,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
INJ TRIGGER POINT 3/> MUSCLES,2330678,CDM,450,RC,20553,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
ARTHROCENTESIS SMALL JOINT BURSA W/O US,2330679,CDM,450,RC,20600,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
ARTHROCENTESIS SMALL JOINT BURSA W/US,2330680,CDM,450,RC,20604,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
ARTHROCENTESIS INTERM JOINT BURSA W/US,2330681,CDM,450,RC,20606,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
ARTHOCENTESIS MAJOR JOINT BURSA W/US,2330682,CDM,450,RC,20611,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
"REMOVE FB SHOULDER, SUBQ",2330683,CDM,450,RC,23330,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
"REMOVE FB SHOULDER, DEEP",2330684,CDM,450,RC,23333,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CLSD TX CLAVICULAR FX W/O MANIPULATION,2330685,CDM,450,RC,23500,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CLSD TX CLAVICULAR FX W/MANIPULATION,2330686,CDM,450,RC,23505,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX PROX HUMERAL FX W/O MANIPULATION,2330687,CDM,450,RC,23600,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX PROX HUMERAL FX W/MANIPULATION,2330688,CDM,450,RC,23605,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RMVL FB UPPER ARM/ELBOW SUBQ,2330689,CDM,450,RC,24200,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RMVL FB UPPER ARM/ELBOW DEEP,2330690,CDM,450,RC,24201,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX HUMERAL SHAFT FX W/O MANIPULATION,2330691,CDM,450,RC,24500,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX HUMERAL SHAFT FX W/MANIPULATION,2330692,CDM,450,RC,24505,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX SPRCND/TRANSCND HUMERAL FX W/O MAN,2330693,CDM,450,RC,24530,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX SPRCND/TRANSCND HUMERAL FX W/MAN,2330694,CDM,450,RC,24535,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX ELBOW DISLOC W/ANESTHESIA,2330695,CDM,450,RC,24605,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX RADIAL HD/NECK FX W/O MANIPULATION,2330696,CDM,450,RC,24650,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX RADIAL HD/NECK FX W/MANIPULATION,2330697,CDM,450,RC,24655,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
"CL TX ULNAR FX, PROX END W/O MANIP",2330698,CDM,450,RC,24670,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
"CL TX ULNAR FX, PROX END W/MANIP",2330699,CDM,450,RC,24675,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX RADIAL SHAFT FX W/O MANIP,2330700,CDM,450,RC,25500,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX RADIAL SHAFT FX W/MANIP,2330701,CDM,450,RC,25505,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX ULNAR SHAFT FX W/O MANIP,2330702,CDM,450,RC,25530,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX ULNAR SHAFT FX W/MANIP,2330703,CDM,450,RC,25535,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX RADIAL & ULNAR SHAFT FX W/O MANIP,2330704,CDM,450,RC,25560,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX RADIAL & ULNAR SHAFT FX W/MANIP,2330705,CDM,450,RC,25565,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX DISTAL RADIAL FX W/O MANIP,2330706,CDM,450,RC,25600,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX METACARPAL FX W/O MANIP EA,2330707,CDM,450,RC,26600,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
I&D FINGER ABSCESS; SIMPLE,2330708,CDM,450,RC,26010,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX METACARPAL FX W/MANIP EA,2330709,CDM,450,RC,26605,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX FINGER DISLOCATION W/MANIP W/O ANESTH,2330710,CDM,450,RC,26700,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX FINGER DISLOCATION W/MANIP W/ANESTHIA,2330711,CDM,450,RC,26705,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX PHALANGEAL SHFT FX W/O MAN,2330712,CDM,450,RC,26720,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX PHALANGEAL SHFT FX W/MAN,2330713,CDM,450,RC,26725,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX DISTAL PHALANGEAL FX W/O MAN,2330714,CDM,450,RC,26750,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX DISTAL PHALANGEAL FX W/MAN,2330715,CDM,450,RC,26755,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RMVL FB PELVIS/HIP SUBQ,2330716,CDM,450,RC,27086,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RMVL FB PELVIS/HIP DEEP,2330717,CDM,450,RC,27087,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
INJECT SI JOINT W/IMAGE GUIDE,2330718,CDM,450,RC,27096,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX KNEE DISLOCATION W/O ANESTHESIA,2330719,CDM,450,RC,27550,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX KNEE DISLOCATION W/ANESTHESIA,2330720,CDM,450,RC,27552,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
PATELLER DISLOC W/O ANESTH,2330721,CDM,450,RC,27560,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX TIBIAL SHAFT FX W/O MAN,2330722,CDM,450,RC,27750,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX TIBIAL SHAFT FX W/MAN,2330723,CDM,450,RC,27752,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX MED MALLEOLUS FX W/O MANIPULATION,2330724,CDM,450,RC,27760,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX MED MALLEOLUS FX W/MANIPULATION,2330725,CDM,450,RC,27762,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX POS MALLEOLUS FX W/O MANIPULATION,2330726,CDM,450,RC,27767,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX POS MALLEOLUS FX W/MANIPULATION,2330727,CDM,450,RC,27768,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX FIBULA PROX/SHAFT FX W/O MANIPULATION,2330728,CDM,450,RC,27780,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX FIBULA PROX/SHAFT FX W/MANIPULATION,2330729,CDM,450,RC,27781,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX FIBULA DISTAL FX W/O MANIPULATION,2330730,CDM,450,RC,27786,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX FIBULA DISTAL FX W/MANIPULATION,2330731,CDM,450,RC,27788,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX BIMALLEOLAR ANKLE FX W/O MANIPULATION,2330732,CDM,450,RC,27808,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX BIMALLEOLAR ANKLE FX W/MANIPULATION,2330733,CDM,450,RC,27810,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX TRIMALLEOLAR ANKLE FX W/O MANIP,2330734,CDM,450,RC,27816,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX TRIMALLEOLAR ANKLE FX W/MANIP,2330735,CDM,450,RC,27818,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX WT BRG ARTCLR PRTN DSTL TIBIA W/O MAN,2330736,CDM,450,RC,27824,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX WT BRG ARTCLR PRTN DSTL TIBIA W/MAN,2330737,CDM,450,RC,27825,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX ANKLE DISLOCATION W/O ANESTHESIA,2330738,CDM,450,RC,27840,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX ANKLE DISLOCATION W/ANESTHESIA,2330739,CDM,450,RC,27842,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RMVL FB FOOT SUBQ,2330740,CDM,450,RC,28190,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RMVL FB FOOT DEEP,2330741,CDM,450,RC,28192,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RMVL FB FOOT COMPLICATED,2330742,CDM,450,RC,28193,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX METATARSAL FX W/O MANIP EA,2330743,CDM,450,RC,28470,HCPCS,Outpatient,,,658,329,,176.74,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,157.92,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,526.4,80,,,percent of total billed charges,80% of total billed charges ,159.5,24.24,,,percent of total billed charges,24.24% of total billed charges ,331.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,493.5,75,,,percent of total billed charges,75% of total billed charges ,161.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,176.74,26.86,,,percent of total billed charges,26.86% of total billed charges,157.92,24,,,percent of total billed charges,24% of total billed charges ,205.3,31.2,,,percent of total billed charges,31.2% of total billed charges,526.4,80,,,percent of total billed charges,80% of total billed charges,157.92,24,,,percent of total billed charges,24% of total billed charges ,157.92,24,,,percent of total billed charges,24% of total billed charges ,157.92,710,
TX METATARSAL FX W/MANIP EA,2330744,CDM,450,RC,28475,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX GREAT TOE FX W/O MANIP,2330745,CDM,450,RC,28490,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX GREAT TOE FX W/MANIP,2330746,CDM,450,RC,28495,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX PHALANGES FX W/O MANIP EA,2330747,CDM,450,RC,28510,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX PHALANGES FX W/MANIP EA,2330748,CDM,450,RC,28515,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX METATAR-PHALANG JNT DISLOC W/ANES,2330749,CDM,450,RC,28635,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX INTERPHALANG JNT DISLOC W/ANES,2330750,CDM,450,RC,28665,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CAST LONG ARM,2330751,CDM,450,RC,29065,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
THORAX STRAPPING,2330752,CDM,450,RC,29200,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
STRAPPING ELBOW OR WRIST,2330753,CDM,450,RC,29260,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
STRAPPING HAND OR FINGER (BUDDY TAPE),2330754,CDM,450,RC,29280,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CAST LONG LEG,2330755,CDM,450,RC,29345,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CAST SHORT LEG,2330756,CDM,450,RC,29405,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
STRAPPING KNEE,2330757,CDM,450,RC,29530,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
STRAPPING ANKLE/FOOT,2330758,CDM,450,RC,29540,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
STRAPPING TOES (BUDDY TAPE),2330759,CDM,450,RC,29550,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
STRAPPING UNNA BOOT,2330760,CDM,450,RC,29580,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RMV FB INTRANASAL,2330761,CDM,450,RC,30300,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
"TRACHEOSTOMY, EMERGENT; CRICOTHYROID MEM",2330762,CDM,450,RC,31605,HCPCS,Outpatient,,,1039.5,519.75,,279.21,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,249.48,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,831.6,80,,,percent of total billed charges,80% of total billed charges ,251.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,523.91,50.4,,,percent of total billed charges,50.4% of total billed charges ,779.63,75,,,percent of total billed charges,75% of total billed charges ,254.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,279.21,26.86,,,percent of total billed charges,26.86% of total billed charges,249.48,24,,,percent of total billed charges,24% of total billed charges ,324.32,31.2,,,percent of total billed charges,31.2% of total billed charges,831.6,80,,,percent of total billed charges,80% of total billed charges,249.48,24,,,percent of total billed charges,24% of total billed charges ,249.48,24,,,percent of total billed charges,24% of total billed charges ,249.48,831.6,
THORACOTOMY W/EXPLORATION,2330763,CDM,450,RC,32100,HCPCS,Outpatient,,,2499,1249.5,,671.23,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,599.76,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,1999.2,80,,,percent of total billed charges,80% of total billed charges ,605.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,1259.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,1874.25,75,,,percent of total billed charges,75% of total billed charges ,611.76,24.48,,,percent of total billed charges,24.48% of total billed charges ,671.23,26.86,,,percent of total billed charges,26.86% of total billed charges,599.76,24,,,percent of total billed charges,24% of total billed charges ,779.69,31.2,,,percent of total billed charges,31.2% of total billed charges,1999.2,80,,,percent of total billed charges,80% of total billed charges,599.76,24,,,percent of total billed charges,24% of total billed charges ,599.76,24,,,percent of total billed charges,24% of total billed charges ,599.76,1999.2,
THORACOTOMY W/CNTRL HEMORRHAGE/RPR LUNG,2330764,CDM,450,RC,32110,HCPCS,Outpatient,,,4552.5,2276.25,,1222.8,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,1092.6,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,3642,80,,,percent of total billed charges,80% of total billed charges ,1103.53,24.24,,,percent of total billed charges,24.24% of total billed charges ,2294.46,50.4,,,percent of total billed charges,50.4% of total billed charges ,3414.38,75,,,percent of total billed charges,75% of total billed charges ,1114.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,1222.8,26.86,,,percent of total billed charges,26.86% of total billed charges,1092.6,24,,,percent of total billed charges,24% of total billed charges ,1420.38,31.2,,,percent of total billed charges,31.2% of total billed charges,3642,80,,,percent of total billed charges,80% of total billed charges,1092.6,24,,,percent of total billed charges,24% of total billed charges ,1092.6,24,,,percent of total billed charges,24% of total billed charges ,710,3642,
THORACOTOMY W/CARDIAC MASSAGE,2330765,CDM,450,RC,32160,HCPCS,Outpatient,,,2453.5,1226.75,,659.01,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,588.84,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,1962.8,80,,,percent of total billed charges,80% of total billed charges ,594.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,1236.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,1840.13,75,,,percent of total billed charges,75% of total billed charges ,600.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,659.01,26.86,,,percent of total billed charges,26.86% of total billed charges,588.84,24,,,percent of total billed charges,24% of total billed charges ,765.49,31.2,,,percent of total billed charges,31.2% of total billed charges,1962.8,80,,,percent of total billed charges,80% of total billed charges,588.84,24,,,percent of total billed charges,24% of total billed charges ,588.84,24,,,percent of total billed charges,24% of total billed charges ,588.84,1962.8,
THORACENTESIS W/ IMAGING,2330766,CDM,450,RC,32555,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
VNPNXR <3 YRS FEM/JUG VEIN PHY/QHP SKILL,2330767,CDM,260,RC,36400,HCPCS,Outpatient,,,83.5,41.75,,22.43,26.86,,,percent of total billed charges,26.86% of total billed charges,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.43,26.86,,,percent of total billed charges,26.86% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,66.8,
VNPNXR 3 YRS/> PHY/QHP SKILL,2330768,CDM,260,RC,36410,HCPCS,Outpatient,,,53.5,26.75,,14.37,26.86,,,percent of total billed charges,26.86% of total billed charges,40.13,75,,,percent of total billed charges,75% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,42.8,80,,,percent of total billed charges,80% of total billed charges ,12.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,13.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.37,26.86,,,percent of total billed charges,26.86% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,16.69,31.2,,,percent of total billed charges,31.2% of total billed charges,42.8,80,,,percent of total billed charges,80% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,42.8,
VNPNXR CUTDOWN <1 YR,2330769,CDM,260,RC,36420,HCPCS,Outpatient,,,148.5,74.25,,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,35.64,24,,,percent of total billed charges,24% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,118.8,80,,,percent of total billed charges,80% of total billed charges ,36,24.24,,,percent of total billed charges,24.24% of total billed charges ,74.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,36.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,35.64,24,,,percent of total billed charges,24% of total billed charges ,46.33,31.2,,,percent of total billed charges,31.2% of total billed charges,118.8,80,,,percent of total billed charges,80% of total billed charges,35.64,24,,,percent of total billed charges,24% of total billed charges ,35.64,24,,,percent of total billed charges,24% of total billed charges ,35.64,118.8,
VNPNXR CUTDOWN >1 YR,2330770,CDM,260,RC,36425,HCPCS,Outpatient,,,124.5,62.25,,33.44,26.86,,,percent of total billed charges,26.86% of total billed charges,93.38,75,,,percent of total billed charges,75% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,29.88,24,,,percent of total billed charges,24% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,99.6,80,,,percent of total billed charges,80% of total billed charges ,30.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,62.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,30.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,33.44,26.86,,,percent of total billed charges,26.86% of total billed charges,29.88,24,,,percent of total billed charges,24% of total billed charges ,38.84,31.2,,,percent of total billed charges,31.2% of total billed charges,99.6,80,,,percent of total billed charges,80% of total billed charges,29.88,24,,,percent of total billed charges,24% of total billed charges ,29.88,24,,,percent of total billed charges,24% of total billed charges ,29.88,99.6,
RMV FB VESTIBULE OF MOUTH SIMPLE,2330772,CDM,450,RC,40804,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RMV FB VESTIBULE OF MOUTH COMPLICATED,2330773,CDM,450,RC,40805,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR LAC 2.5CM/< POSTERIOR TONGUE,2330774,CDM,450,RC,41251,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR LAC TONGUE 2.6CM/> OR COMPLEX,2330775,CDM,450,RC,41252,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
I&D PERITONSILLAR,2330776,CDM,450,RC,42700,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CHANGE GASTROSTOMY TUBE W/O IMAGING,2330777,CDM,450,RC,43762,HCPCS,Outpatient,,,687,343.5,,184.53,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,164.88,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,549.6,80,,,percent of total billed charges,80% of total billed charges ,166.53,24.24,,,percent of total billed charges,24.24% of total billed charges ,346.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,515.25,75,,,percent of total billed charges,75% of total billed charges ,168.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,184.53,26.86,,,percent of total billed charges,26.86% of total billed charges,164.88,24,,,percent of total billed charges,24% of total billed charges ,214.34,31.2,,,percent of total billed charges,31.2% of total billed charges,549.6,80,,,percent of total billed charges,80% of total billed charges,164.88,24,,,percent of total billed charges,24% of total billed charges ,164.88,24,,,percent of total billed charges,24% of total billed charges ,164.88,710,
I&D PERIANAL ABSCESS,2330778,CDM,450,RC,46050,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
EXC THROMBOSED HEMORRHOID XTRNL,2330779,CDM,450,RC,46320,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
ANOSCOPY,2330780,CDM,450,RC,46600,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
ANOSCOPY W/RMVL FB,2330781,CDM,450,RC,46608,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
ABD PARACENTESIS W/IMAGING,2330782,CDM,450,RC,49083,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
URINARY CATHETER COMPLEX,2330783,CDM,450,RC,51703,HCPCS,Outpatient,,,455.5,227.75,,122.35,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,109.32,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,364.4,80,,,percent of total billed charges,80% of total billed charges ,110.41,24.24,,,percent of total billed charges,24.24% of total billed charges ,229.57,50.4,,,percent of total billed charges,50.4% of total billed charges ,341.63,75,,,percent of total billed charges,75% of total billed charges ,111.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,122.35,26.86,,,percent of total billed charges,26.86% of total billed charges,109.32,24,,,percent of total billed charges,24% of total billed charges ,142.12,31.2,,,percent of total billed charges,31.2% of total billed charges,364.4,80,,,percent of total billed charges,80% of total billed charges,109.32,24,,,percent of total billed charges,24% of total billed charges ,109.32,24,,,percent of total billed charges,24% of total billed charges ,109.32,710,
MEASURE BLADDER CAPACITY VIA US,2330784,CDM,450,RC,51798,HCPCS,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,710,
I&D SCROTAL ABSCESS,2330785,CDM,450,RC,55100,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
PLACENTA DELIVERY,2330786,CDM,450,RC,59414,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
INJ AA/STRD TRIGEMINAL NERVE EA BRANCH,2330787,CDM,450,RC,64400,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
INJ AA/STRD GRTR OCCIPITAL NERVE,2330788,CDM,450,RC,64405,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
INJ AA/STRD PERIPHERAL NERVE,2330789,CDM,450,RC,64450,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
INJ PVRT FACET JT CRV/THRC 1 LVL W/IMAG,2330790,CDM,450,RC,64490,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
INJ PVRT FACET JT LUM/SAC 1 LVL W/IMAG,2330791,CDM,450,RC,64493,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
"RMV FB EXT EYE, CONJUNCTIVAL SUPERFICIAL",2330792,CDM,450,RC,65205,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
"RMV FB EXT EYE, CONJUNCTIVAL EMBEDDED",2330793,CDM,450,RC,65210,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RMV FB EXT EYE CORNEAL W/O SLIT LAMP,2330794,CDM,450,RC,65220,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RMV FB EXT EYE CORNEAL W/SLIT LAMP,2330795,CDM,450,RC,65222,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RMV CORNEAL EPITHELIUM W/WO CHEMOCAUTERY,2330796,CDM,450,RC,65435,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RMV FB EYELID EMBEDDED,2330797,CDM,450,RC,67938,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CARDIOVERSION INTERNAL,2330798,CDM,450,RC,92961,HCPCS,Outpatient,,,1011.5,505.75,,271.69,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,242.76,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,809.2,80,,,percent of total billed charges,80% of total billed charges ,245.19,24.24,,,percent of total billed charges,24.24% of total billed charges ,509.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,758.63,75,,,percent of total billed charges,75% of total billed charges ,247.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,271.69,26.86,,,percent of total billed charges,26.86% of total billed charges,242.76,24,,,percent of total billed charges,24% of total billed charges ,315.59,31.2,,,percent of total billed charges,31.2% of total billed charges,809.2,80,,,percent of total billed charges,80% of total billed charges,242.76,24,,,percent of total billed charges,24% of total billed charges ,242.76,24,,,percent of total billed charges,24% of total billed charges ,242.76,809.2,
PACEMAKER INTERROGATION,2330799,CDM,482,RC,93288,HCPCS,Outpatient,,,69,34.5,,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,55.2,80,,,percent of total billed charges,80% of total billed charges ,16.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,21.53,31.2,,,percent of total billed charges,31.2% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,55.2,
TRANSVENOUS PACEMAKER INSERTION,2330800,CDM,450,RC,93583,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
EPLEY MANEUVER,2330801,CDM,450,RC,95992,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
MODERATE SEDATION <5 YRS INITIAL 15 MIN,2330802,CDM,450,RC,99151,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
MODERATE SEDATION >5 YRS INITIAL 15 MIN,2330803,CDM,450,RC,99152,HCPCS,Outpatient,,,153.5,76.75,,41.23,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,36.84,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,122.8,80,,,percent of total billed charges,80% of total billed charges ,37.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,77.36,50.4,,,percent of total billed charges,50.4% of total billed charges ,115.13,75,,,percent of total billed charges,75% of total billed charges ,37.58,24.48,,,percent of total billed charges,24.48% of total billed charges ,41.23,26.86,,,percent of total billed charges,26.86% of total billed charges,36.84,24,,,percent of total billed charges,24% of total billed charges ,47.89,31.2,,,percent of total billed charges,31.2% of total billed charges,122.8,80,,,percent of total billed charges,80% of total billed charges,36.84,24,,,percent of total billed charges,24% of total billed charges ,36.84,24,,,percent of total billed charges,24% of total billed charges ,36.84,710,
MODERATE SEDATION EA ADDL 15 MIN,2330804,CDM,450,RC,99153,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
MOD SEDATION <5YRS INIT 15 MIN OTHR PHYS,2330805,CDM,450,RC,99155,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
MOD SEDATION <5YRS INIT 15 MIN OTHR PHYS,2330806,CDM,450,RC,99156,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
MOD SEDATION EA ADDL15 MIN OTHR PHYS,2330807,CDM,450,RC,99157,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
INST NON DWELLING BLADDER CATH,2330808,CDM,450,RC,51701,HCPCS,Outpatient,,,136,68,,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,108.8,80,,,percent of total billed charges,80% of total billed charges ,32.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,33.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,42.43,31.2,,,percent of total billed charges,31.2% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,710,
IMMUNIZATION ADMIN EA ADDL VACCINE,2330809,CDM,771,RC,90472,HCPCS,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
RPR EXTSR TENDON HAND W/O GRAFT EA,2330810,CDM,450,RC,26410,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
RPR EXTSR TENDON FINGER W/O GRAFT EA,2330811,CDM,450,RC,26418,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX HIP DISLOCATION TRAUMA W/O ANESTHESIA,2330812,CDM,450,RC,27250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX HIP DISLOCATION TRAUMA W/ANESTHESIA,2330813,CDM,450,RC,27252,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX HIP DISLOCATION SPONT W/O MANIP/ANEST,2330814,CDM,450,RC,27256,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX HIP DISLOCATION SPONT W/MANIP/ANEST,2330815,CDM,450,RC,27257,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX POST HIP ARTHROPLASTY DISLOC W/O ANES,2330816,CDM,450,RC,27265,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
TX POST HIP ARTHROPLASTY DISLOC W/ANES,2330817,CDM,450,RC,27266,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX FEMORAL SHAFT FX W/O MANIPULATION,2330818,CDM,450,RC,27500,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX SPRCNDYLR/TRNS FX W/O MANIPULATION,2330819,CDM,450,RC,27501,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX FEM SHFT FX W/O MANIPULATION,2330820,CDM,450,RC,27502,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CL TX SPRCNDYLR FX W/MAN W/WO TRACT,2330821,CDM,450,RC,27503,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CLTX FEM FX DST END MED/LAT CNDL W/O MAN,2330822,CDM,450,RC,27508,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CLTX FEM FX DST END MED/LAT CNDL W/MAN,2330823,CDM,450,RC,27510,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
ARTL CATH/CANNUL MNTR/XFUSE/SAMPLE SPX P,2330824,CDM,450,RC,36620,HCPCS,Outpatient,,,138,69,,37.07,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,33.12,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,110.4,80,,,percent of total billed charges,80% of total billed charges ,33.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,69.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,33.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.07,26.86,,,percent of total billed charges,26.86% of total billed charges,33.12,24,,,percent of total billed charges,24% of total billed charges ,43.06,31.2,,,percent of total billed charges,31.2% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,33.12,24,,,percent of total billed charges,24% of total billed charges ,33.12,24,,,percent of total billed charges,24% of total billed charges ,33.12,710,
THROMBOLYSIS CEREBRAL  IV INFUSION,2330825,CDM,450,RC,37195,HCPCS,Outpatient,,,1196,598,,321.25,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,287.04,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,956.8,80,,,percent of total billed charges,80% of total billed charges ,289.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,602.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,897,75,,,percent of total billed charges,75% of total billed charges ,292.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,321.25,26.86,,,percent of total billed charges,26.86% of total billed charges,287.04,24,,,percent of total billed charges,24% of total billed charges ,373.15,31.2,,,percent of total billed charges,31.2% of total billed charges,956.8,80,,,percent of total billed charges,80% of total billed charges,287.04,24,,,percent of total billed charges,24% of total billed charges ,287.04,24,,,percent of total billed charges,24% of total billed charges ,287.04,956.8,
PERITONEAL LAVAGE W/WO IMAGING,2330826,CDM,450,RC,49084,HCPCS,Outpatient,,,333.5,166.75,,89.58,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,80.04,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,266.8,80,,,percent of total billed charges,80% of total billed charges ,80.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,168.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,250.13,75,,,percent of total billed charges,75% of total billed charges ,81.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,89.58,26.86,,,percent of total billed charges,26.86% of total billed charges,80.04,24,,,percent of total billed charges,24% of total billed charges ,104.05,31.2,,,percent of total billed charges,31.2% of total billed charges,266.8,80,,,percent of total billed charges,80% of total billed charges,80.04,24,,,percent of total billed charges,24% of total billed charges ,80.04,24,,,percent of total billed charges,24% of total billed charges ,80.04,710,
TX INTERPHALANGEAL JNT DISLOC W/O ANESTH,2330827,CDM,450,RC,28660,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CLOSED TX TALUS FX W/O MANIPULATION,2330828,CDM,450,RC,28430,HCPCS,Outpatient,,,658,329,,176.74,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,157.92,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,526.4,80,,,percent of total billed charges,80% of total billed charges ,159.5,24.24,,,percent of total billed charges,24.24% of total billed charges ,331.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,493.5,75,,,percent of total billed charges,75% of total billed charges ,161.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,176.74,26.86,,,percent of total billed charges,26.86% of total billed charges,157.92,24,,,percent of total billed charges,24% of total billed charges ,205.3,31.2,,,percent of total billed charges,31.2% of total billed charges,526.4,80,,,percent of total billed charges,80% of total billed charges,157.92,24,,,percent of total billed charges,24% of total billed charges ,157.92,24,,,percent of total billed charges,24% of total billed charges ,157.92,710,
CL TX CARPAL SCAPHOID FX W/O MANIP,2330829,CDM,450,RC,25622,HCPCS,Outpatient,,,1024,512,,275.05,26.86,,,percent of total billed charges,26.86% of total billed charges,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,245.76,24,,,percent of total billed charges,24% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,819.2,80,,,percent of total billed charges,80% of total billed charges ,248.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,516.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,768,75,,,percent of total billed charges,75% of total billed charges ,250.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,275.05,26.86,,,percent of total billed charges,26.86% of total billed charges,245.76,24,,,percent of total billed charges,24% of total billed charges ,319.49,31.2,,,percent of total billed charges,31.2% of total billed charges,819.2,80,,,percent of total billed charges,80% of total billed charges,245.76,24,,,percent of total billed charges,24% of total billed charges ,245.76,24,,,percent of total billed charges,24% of total billed charges ,245.76,819.2,
NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT,2330830,CDM,450,RC,54235,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
REMOVAL NAIL BED - PERMANENT,2400009,CDM,450,RC,11750,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
ULTRASOUND GUIDANCE,2400094,CDM,450,RC,76937,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
CULTURE SWAB,2500002,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
BEDPAN,2500003,CDM,270,RC,,,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
BEDPAN FRACTURE,2500004,CDM,270,RC,,,Outpatient,,,41,20.5,,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,32.8,80,,,percent of total billed charges,80% of total billed charges ,9.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,10.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,12.79,31.2,,,percent of total billed charges,31.2% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,32.8,
ENEMA SET,2500005,CDM,270,RC,,,Outpatient,,,72,36,,19.34,26.86,,,percent of total billed charges,26.86% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.34,26.86,,,percent of total billed charges,26.86% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,57.6,
ICE PACK,2500006,CDM,270,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
DIAPER ADULT LARGE,2500009,CDM,270,RC,,,Outpatient,,,74,37,,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,55.5,75,,,percent of total billed charges,75% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,59.2,80,,,percent of total billed charges,80% of total billed charges ,17.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,18.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,23.09,31.2,,,percent of total billed charges,31.2% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,59.2,
DIAPER ADULTXL,2500010,CDM,270,RC,,,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
INSYTE AUTOGUARD 24GA.,2500011,CDM,270,RC,,,Outpatient,,,93.5,46.75,,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,74.8,80,,,percent of total billed charges,80% of total billed charges ,22.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,29.17,31.2,,,percent of total billed charges,31.2% of total billed charges,74.8,80,,,percent of total billed charges,80% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,74.8,
INTROCAN   22X1,2500012,CDM,270,RC,,,Outpatient,,,93.5,46.75,,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,74.8,80,,,percent of total billed charges,80% of total billed charges ,22.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,29.17,31.2,,,percent of total billed charges,31.2% of total billed charges,74.8,80,,,percent of total billed charges,80% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,74.8,
INTROCAN  20X1,2500013,CDM,270,RC,,,Outpatient,,,93.5,46.75,,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,74.8,80,,,percent of total billed charges,80% of total billed charges ,22.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,29.17,31.2,,,percent of total billed charges,31.2% of total billed charges,74.8,80,,,percent of total billed charges,80% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,74.8,
INTROCAN 18G,2500014,CDM,270,RC,,,Outpatient,,,93.5,46.75,,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,74.8,80,,,percent of total billed charges,80% of total billed charges ,22.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,29.17,31.2,,,percent of total billed charges,31.2% of total billed charges,74.8,80,,,percent of total billed charges,80% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,74.8,
INTROCAN 16G,2500015,CDM,270,RC,,,Outpatient,,,41,20.5,,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,32.8,80,,,percent of total billed charges,80% of total billed charges ,9.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,10.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,12.79,31.2,,,percent of total billed charges,31.2% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,32.8,
INTROCAN 14G,2500016,CDM,270,RC,,,Outpatient,,,41,20.5,,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,32.8,80,,,percent of total billed charges,80% of total billed charges ,9.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,10.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,12.79,31.2,,,percent of total billed charges,31.2% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,32.8,
GRIPPER 20GA X 1,2500031,CDM,272,RC,,,Outpatient,,,83.5,41.75,,22.43,26.86,,,percent of total billed charges,26.86% of total billed charges,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.43,26.86,,,percent of total billed charges,26.86% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,66.8,
BUTTERFLY 19GA  X7/8,2500033,CDM,270,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
BUTTERFLY 25GA  X1/2,2500034,CDM,270,RC,,,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
ART LINE ARM BD,2500038,CDM,270,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
ADULT WIPES,2500039,CDM,270,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
TRIPLE LUM CATH 16FR.,2500044,CDM,278,RC,C1751,HCPCS,Outpatient,,,872.5,436.25,,234.35,26.86,,,percent of total billed charges,26.86% of total billed charges,654.38,75,,,percent of total billed charges,75% of total billed charges ,654.38,75,,,percent of total billed charges,75% of total billed charges ,209.4,24,,,percent of total billed charges,24% of total billed charges ,654.38,75,,,percent of total billed charges,75% of total billed charges ,654.38,75,,,percent of total billed charges,75% of total billed charges ,698,80,,,percent of total billed charges,80% of total billed charges ,211.49,24.24,,,percent of total billed charges,24.24% of total billed charges ,439.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,654.38,75,,,percent of total billed charges,75% of total billed charges ,213.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,234.35,26.86,,,percent of total billed charges,26.86% of total billed charges,209.4,24,,,percent of total billed charges,24% of total billed charges ,272.22,31.2,,,percent of total billed charges,31.2% of total billed charges,698,80,,,percent of total billed charges,80% of total billed charges,209.4,24,,,percent of total billed charges,24% of total billed charges ,209.4,24,,,percent of total billed charges,24% of total billed charges ,209.4,698,
THORACENTESIS TRAY,2500046,CDM,272,RC,,,Outpatient,,,331.5,165.75,,89.04,26.86,,,percent of total billed charges,26.86% of total billed charges,248.63,75,,,percent of total billed charges,75% of total billed charges ,248.63,75,,,percent of total billed charges,75% of total billed charges ,79.56,24,,,percent of total billed charges,24% of total billed charges ,248.63,75,,,percent of total billed charges,75% of total billed charges ,248.63,75,,,percent of total billed charges,75% of total billed charges ,265.2,80,,,percent of total billed charges,80% of total billed charges ,80.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,167.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,248.63,75,,,percent of total billed charges,75% of total billed charges ,81.15,24.48,,,percent of total billed charges,24.48% of total billed charges ,89.04,26.86,,,percent of total billed charges,26.86% of total billed charges,79.56,24,,,percent of total billed charges,24% of total billed charges ,103.43,31.2,,,percent of total billed charges,31.2% of total billed charges,265.2,80,,,percent of total billed charges,80% of total billed charges,79.56,24,,,percent of total billed charges,24% of total billed charges ,79.56,24,,,percent of total billed charges,24% of total billed charges ,79.56,265.2,
LUMBAR PUNT TRAY,2500048,CDM,272,RC,,,Outpatient,,,121.5,60.75,,32.63,26.86,,,percent of total billed charges,26.86% of total billed charges,91.13,75,,,percent of total billed charges,75% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,97.2,80,,,percent of total billed charges,80% of total billed charges ,29.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.63,26.86,,,percent of total billed charges,26.86% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,37.91,31.2,,,percent of total billed charges,31.2% of total billed charges,97.2,80,,,percent of total billed charges,80% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,97.2,
RAPE EXAM KIT,2500049,CDM,270,RC,,,Outpatient,,,119.5,59.75,,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,95.6,
CENTRAL VENOUS SET,2500050,CDM,278,RC,C1751,HCPCS,Outpatient,,,246,123,,66.08,26.86,,,percent of total billed charges,26.86% of total billed charges,246,75,,,percent of total billed charges,75% of total billed charges ,246,75,,,percent of total billed charges,75% of total billed charges ,59.04,24,,,percent of total billed charges,24% of total billed charges ,246,75,,,percent of total billed charges,75% of total billed charges ,246,75,,,percent of total billed charges,75% of total billed charges ,196.8,80,,,percent of total billed charges,80% of total billed charges ,59.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,123.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,184.5,75,,,percent of total billed charges,75% of total billed charges ,60.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,66.08,26.86,,,percent of total billed charges,26.86% of total billed charges,59.04,24,,,percent of total billed charges,24% of total billed charges ,76.75,31.2,,,percent of total billed charges,31.2% of total billed charges,196.8,80,,,percent of total billed charges,80% of total billed charges,59.04,24,,,percent of total billed charges,24% of total billed charges ,59.04,24,,,percent of total billed charges,24% of total billed charges ,59.04,246,
NEEDLE LOCK DEVICE,2500052,CDM,270,RC,,,Outpatient,,,5,2.5,,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,4,80,,,percent of total billed charges,80% of total billed charges ,1.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,2.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.56,31.2,,,percent of total billed charges,31.2% of total billed charges,4,80,,,percent of total billed charges,80% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,4,
SPRING WIRE GUIDE,2500055,CDM,270,RC,,,Outpatient,,,42,21,,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,33.6,80,,,percent of total billed charges,80% of total billed charges ,10.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,13.1,31.2,,,percent of total billed charges,31.2% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,33.6,
CARRA-KLENZ,2500056,CDM,250,RC,,,Outpatient,,,152.5,76.25,,40.96,26.86,,,percent of total billed charges,26.86% of total billed charges,114.38,75,,,percent of total billed charges,75% of total billed charges ,114.38,75,,,percent of total billed charges,75% of total billed charges ,36.6,24,,,percent of total billed charges,24% of total billed charges ,114.38,75,,,percent of total billed charges,75% of total billed charges ,114.38,75,,,percent of total billed charges,75% of total billed charges ,122,80,,,percent of total billed charges,80% of total billed charges ,36.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,76.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,114.38,75,,,percent of total billed charges,75% of total billed charges ,37.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,40.96,26.86,,,percent of total billed charges,26.86% of total billed charges,36.6,24,,,percent of total billed charges,24% of total billed charges ,47.58,31.2,,,percent of total billed charges,31.2% of total billed charges,122,80,,,percent of total billed charges,80% of total billed charges,36.6,24,,,percent of total billed charges,24% of total billed charges ,36.6,24,,,percent of total billed charges,24% of total billed charges ,36.6,122,
PLEUREVAC,2500068,CDM,272,RC,,,Outpatient,,,559.5,279.75,,150.28,26.86,,,percent of total billed charges,26.86% of total billed charges,419.63,75,,,percent of total billed charges,75% of total billed charges ,419.63,75,,,percent of total billed charges,75% of total billed charges ,134.28,24,,,percent of total billed charges,24% of total billed charges ,419.63,75,,,percent of total billed charges,75% of total billed charges ,419.63,75,,,percent of total billed charges,75% of total billed charges ,447.6,80,,,percent of total billed charges,80% of total billed charges ,135.62,24.24,,,percent of total billed charges,24.24% of total billed charges ,281.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,419.63,75,,,percent of total billed charges,75% of total billed charges ,136.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,150.28,26.86,,,percent of total billed charges,26.86% of total billed charges,134.28,24,,,percent of total billed charges,24% of total billed charges ,174.56,31.2,,,percent of total billed charges,31.2% of total billed charges,447.6,80,,,percent of total billed charges,80% of total billed charges,134.28,24,,,percent of total billed charges,24% of total billed charges ,134.28,24,,,percent of total billed charges,24% of total billed charges ,134.28,447.6,
ARM BOARD INFANT,2500069,CDM,270,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ARMBOARD 9,2500070,CDM,270,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ARMBOARD 18,2500071,CDM,270,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
BONE MARROW NEEDLE,2500073,CDM,272,RC,,,Outpatient,,,143,71.5,,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,114.4,80,,,percent of total billed charges,80% of total billed charges ,34.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,35.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,44.62,31.2,,,percent of total billed charges,31.2% of total billed charges,114.4,80,,,percent of total billed charges,80% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,114.4,
SUCTION CATH 6FR,2500075,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
SUCTION CATH 8FR,2500076,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
SUCTION CATH 10FR,2500077,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
SUCTION CATH 12FR,2500078,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
SUCTION CATH 14FR,2500079,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
SUCTION CATH 16FR,2500080,CDM,270,RC,,,Outpatient,,,43.5,21.75,,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,34.8,80,,,percent of total billed charges,80% of total billed charges ,10.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,10.44,24,,,percent of total billed charges,24% of total billed charges ,13.57,31.2,,,percent of total billed charges,31.2% of total billed charges,34.8,80,,,percent of total billed charges,80% of total billed charges,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,34.8,
SUCTION CATH 18FR,2500081,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
SUCTION CATH TRAY 14FR,2500082,CDM,270,RC,,,Outpatient,,,72,36,,19.34,26.86,,,percent of total billed charges,26.86% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.34,26.86,,,percent of total billed charges,26.86% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,57.6,
TRACH CLEANING TRAY,2500083,CDM,270,RC,,,Outpatient,,,53.5,26.75,,14.37,26.86,,,percent of total billed charges,26.86% of total billed charges,40.13,75,,,percent of total billed charges,75% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,42.8,80,,,percent of total billed charges,80% of total billed charges ,12.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,13.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.37,26.86,,,percent of total billed charges,26.86% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,16.69,31.2,,,percent of total billed charges,31.2% of total billed charges,42.8,80,,,percent of total billed charges,80% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,42.8,
SUCTION CANNISTER 1200,2500084,CDM,270,RC,,,Outpatient,,,57.5,28.75,,15.44,26.86,,,percent of total billed charges,26.86% of total billed charges,43.13,75,,,percent of total billed charges,75% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,13.8,24,,,percent of total billed charges,24% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,46,80,,,percent of total billed charges,80% of total billed charges ,13.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,14.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.44,26.86,,,percent of total billed charges,26.86% of total billed charges,13.8,24,,,percent of total billed charges,24% of total billed charges ,17.94,31.2,,,percent of total billed charges,31.2% of total billed charges,46,80,,,percent of total billed charges,80% of total billed charges,13.8,24,,,percent of total billed charges,24% of total billed charges ,13.8,24,,,percent of total billed charges,24% of total billed charges ,13.8,46,
RED RUBBER 10FR,2500085,CDM,272,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
RED RUBBER 12 FR,2500086,CDM,272,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
RED RUBBER 14FR,2500087,CDM,272,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
RED RUBBER 16FR,2500088,CDM,272,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
RED RUBBER 18FR,2500089,CDM,272,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
FOLEY TRAY 14FR,2500091,CDM,272,RC,,,Outpatient,,,136,68,,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,108.8,80,,,percent of total billed charges,80% of total billed charges ,32.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,33.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,42.43,31.2,,,percent of total billed charges,31.2% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,108.8,
FOLEY TRAY 16FR,2500092,CDM,270,RC,,,Outpatient,,,306,153,,82.19,26.86,,,percent of total billed charges,26.86% of total billed charges,229.5,75,,,percent of total billed charges,75% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,73.44,24,,,percent of total billed charges,24% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,244.8,80,,,percent of total billed charges,80% of total billed charges ,74.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,154.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,74.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,82.19,26.86,,,percent of total billed charges,26.86% of total billed charges,73.44,24,,,percent of total billed charges,24% of total billed charges ,95.47,31.2,,,percent of total billed charges,31.2% of total billed charges,244.8,80,,,percent of total billed charges,80% of total billed charges,73.44,24,,,percent of total billed charges,24% of total billed charges ,73.44,24,,,percent of total billed charges,24% of total billed charges ,73.44,244.8,
FOLEY TRAY 18FR,2500093,CDM,270,RC,,,Outpatient,,,306,153,,82.19,26.86,,,percent of total billed charges,26.86% of total billed charges,229.5,75,,,percent of total billed charges,75% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,73.44,24,,,percent of total billed charges,24% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,244.8,80,,,percent of total billed charges,80% of total billed charges ,74.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,154.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,74.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,82.19,26.86,,,percent of total billed charges,26.86% of total billed charges,73.44,24,,,percent of total billed charges,24% of total billed charges ,95.47,31.2,,,percent of total billed charges,31.2% of total billed charges,244.8,80,,,percent of total billed charges,80% of total billed charges,73.44,24,,,percent of total billed charges,24% of total billed charges ,73.44,24,,,percent of total billed charges,24% of total billed charges ,73.44,244.8,
CATH MALE MED TEXAS,2500094,CDM,270,RC,,,Outpatient,,,41,20.5,,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,32.8,80,,,percent of total billed charges,80% of total billed charges ,9.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,10.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,12.79,31.2,,,percent of total billed charges,31.2% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,32.8,
MALE EXTERNAL DEVICE,2500095,CDM,270,RC,,,Outpatient,,,41,20.5,,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,32.8,80,,,percent of total billed charges,80% of total billed charges ,9.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,10.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,12.79,31.2,,,percent of total billed charges,31.2% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,32.8,
DRAINAGE BAG,2500098,CDM,272,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
STOMACH TUBE 16FR,2500102,CDM,272,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
STOMACH TUBE 18FR,2500103,CDM,272,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
STOMACH TUBE 14FR,2500104,CDM,272,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
FEEDING TUBE 8FR,2500105,CDM,270,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
FLEXIFLO 8FR,2500106,CDM,272,RC,,,Outpatient,,,168,84,,45.12,26.86,,,percent of total billed charges,26.86% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges ,126,75,,,percent of total billed charges,75% of total billed charges ,40.32,24,,,percent of total billed charges,24% of total billed charges ,126,75,,,percent of total billed charges,75% of total billed charges ,126,75,,,percent of total billed charges,75% of total billed charges ,134.4,80,,,percent of total billed charges,80% of total billed charges ,40.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,84.67,50.4,,,percent of total billed charges,50.4% of total billed charges ,126,75,,,percent of total billed charges,75% of total billed charges ,41.13,24.48,,,percent of total billed charges,24.48% of total billed charges ,45.12,26.86,,,percent of total billed charges,26.86% of total billed charges,40.32,24,,,percent of total billed charges,24% of total billed charges ,52.42,31.2,,,percent of total billed charges,31.2% of total billed charges,134.4,80,,,percent of total billed charges,80% of total billed charges,40.32,24,,,percent of total billed charges,24% of total billed charges ,40.32,24,,,percent of total billed charges,24% of total billed charges ,40.32,134.4,
LEVIN TUBE 10FR,2500108,CDM,272,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
LEVIN TUBE 12FR,2500109,CDM,272,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
LEVIN TUBE 14FR,2500110,CDM,272,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
SALEM SUMP 16FR,2500111,CDM,272,RC,,,Outpatient,,,69,34.5,,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,55.2,80,,,percent of total billed charges,80% of total billed charges ,16.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,21.53,31.2,,,percent of total billed charges,31.2% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,55.2,
SALEM SUMP 18FR,2500112,CDM,272,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
KANGAROO WITH ICE POUCH,2500113,CDM,270,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
KANGAROO DOUBLE FEEDIND BAG,2500114,CDM,270,RC,,,Outpatient,,,83.5,41.75,,22.43,26.86,,,percent of total billed charges,26.86% of total billed charges,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.43,26.86,,,percent of total billed charges,26.86% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,66.8,
E.TRACH TUBE UNCUFF 2.5,2500120,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
E.TRACH TUBE UNCUFFED 3.0,2500121,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
E.TRACH TUBE UNCUFFED 3.5,2500122,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
E.TRACH TUBE UNCUFFED 4.0,2500123,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
E TRACH TUBE UNCUFFED 4.5,2500124,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
ETRACH TUBE UNCUFFED 5.0,2500125,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
E.TRACH TUBE UNCUFFED 5.5,2500126,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
E.TRACH TUBE CUFF 5.0,2500127,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
E.TRACH TUBE 5.5,2500128,CDM,270,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
"E,TRACH TUBE 6.0",2500129,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
E.TRACH TUBE CUFF 6.5,2500130,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
E.TRACH TUBE CUFF 7.0,2500131,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
E. TRACH TUBE CUFF 7.5,2500132,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
E.TRACH TUBE CUFF 8.5,2500133,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
E. TRACH TUBE 8.0,2500134,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
E.TRACH TUBE CUFF 9.0,2500135,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
E. TRACH TUBE CUFF 10.0,2500136,CDM,270,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
AIRWAY 40MM,2500137,CDM,270,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
AIRWAY 60MM,2500138,CDM,270,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
AIRWAY 70MM,2500139,CDM,270,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
AIRWAY 80MM,2500140,CDM,270,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
AIRWAY 90MM,2500141,CDM,270,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
AIRWAY 100MM,2500142,CDM,270,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
AIRWAY 110MM,2500143,CDM,270,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
SMOKING CESSATION,2500145,CDM,410,RC,99406,HCPCS,Outpatient,,,133,66.5,,35.72,26.86,,,percent of total billed charges,26.86% of total billed charges,99.75,75,,,percent of total billed charges,75% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,31.92,24,,,percent of total billed charges,24% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,106.4,80,,,percent of total billed charges,80% of total billed charges ,32.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,67.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,32.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.72,26.86,,,percent of total billed charges,26.86% of total billed charges,31.92,24,,,percent of total billed charges,24% of total billed charges ,41.5,31.2,,,percent of total billed charges,31.2% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,31.92,24,,,percent of total billed charges,24% of total billed charges ,31.92,24,,,percent of total billed charges,24% of total billed charges ,31.92,106.4,
FEEDING TUBE INFANT 5FR`,2500146,CDM,270,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
BASIN 7QT,2500150,CDM,270,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
VEST REST SM,2500151,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
VEST REST MD,2500152,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
VEST REST LG,2500153,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
LIMB HOLDER,2500154,CDM,270,RC,,,Outpatient,,,96,48,,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,76.8,
GAUZE 4X4 X12PLY S,2500157,CDM,270,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
COMBINE DRESSING SURGIPAD,2500158,CDM,270,RC,,,Outpatient,,,2,1,,0.54,26.86,,,percent of total billed charges,26.86% of total billed charges,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,0.48,24,,,percent of total billed charges,24% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.6,80,,,percent of total billed charges,80% of total billed charges ,0.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,1.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,0.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.54,26.86,,,percent of total billed charges,26.86% of total billed charges,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.62,31.2,,,percent of total billed charges,31.2% of total billed charges,1.6,80,,,percent of total billed charges,80% of total billed charges,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.48,1.6,
KLING 2  S,2500159,CDM,270,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
KLING 3  S,2500160,CDM,270,RC,,,Outpatient,,,43.5,21.75,,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,34.8,80,,,percent of total billed charges,80% of total billed charges ,10.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,10.44,24,,,percent of total billed charges,24% of total billed charges ,13.57,31.2,,,percent of total billed charges,31.2% of total billed charges,34.8,80,,,percent of total billed charges,80% of total billed charges,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,34.8,
KLING 4  S,2500161,CDM,270,RC,,,Outpatient,,,55.5,27.75,,14.91,26.86,,,percent of total billed charges,26.86% of total billed charges,41.63,75,,,percent of total billed charges,75% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,13.32,24,,,percent of total billed charges,24% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,44.4,80,,,percent of total billed charges,80% of total billed charges ,13.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,27.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,13.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.91,26.86,,,percent of total billed charges,26.86% of total billed charges,13.32,24,,,percent of total billed charges,24% of total billed charges ,17.32,31.2,,,percent of total billed charges,31.2% of total billed charges,44.4,80,,,percent of total billed charges,80% of total billed charges,13.32,24,,,percent of total billed charges,24% of total billed charges ,13.32,24,,,percent of total billed charges,24% of total billed charges ,13.32,44.4,
KLING 6  S,2500162,CDM,270,RC,,,Outpatient,,,63,31.5,,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,50.4,
GAUZE4X4 16PLY S,2500171,CDM,270,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
GAUZE 2X2 8PLY S,2500172,CDM,270,RC,,,Outpatient,,,2,1,,0.54,26.86,,,percent of total billed charges,26.86% of total billed charges,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,0.48,24,,,percent of total billed charges,24% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.6,80,,,percent of total billed charges,80% of total billed charges ,0.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,1.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,0.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.54,26.86,,,percent of total billed charges,26.86% of total billed charges,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.62,31.2,,,percent of total billed charges,31.2% of total billed charges,1.6,80,,,percent of total billed charges,80% of total billed charges,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.48,1.6,
EYE PAD SMALL,2500173,CDM,270,RC,,,Outpatient,,,11.5,5.75,,3.09,26.86,,,percent of total billed charges,26.86% of total billed charges,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,9.2,80,,,percent of total billed charges,80% of total billed charges ,2.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.09,26.86,,,percent of total billed charges,26.86% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,3.59,31.2,,,percent of total billed charges,31.2% of total billed charges,9.2,80,,,percent of total billed charges,80% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,9.2,
KERLIX S,2500176,CDM,270,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
KERLIX SUPER,2500178,CDM,270,RC,,,Outpatient,,,8,4,,2.15,26.86,,,percent of total billed charges,26.86% of total billed charges,6,75,,,percent of total billed charges,75% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,6.4,80,,,percent of total billed charges,80% of total billed charges ,1.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.15,26.86,,,percent of total billed charges,26.86% of total billed charges,1.92,24,,,percent of total billed charges,24% of total billed charges ,2.5,31.2,,,percent of total billed charges,31.2% of total billed charges,6.4,80,,,percent of total billed charges,80% of total billed charges,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,6.4,
K-PADS,2500179,CDM,270,RC,,,Outpatient,,,215.5,107.75,,57.88,26.86,,,percent of total billed charges,26.86% of total billed charges,161.63,75,,,percent of total billed charges,75% of total billed charges ,161.63,75,,,percent of total billed charges,75% of total billed charges ,51.72,24,,,percent of total billed charges,24% of total billed charges ,161.63,75,,,percent of total billed charges,75% of total billed charges ,161.63,75,,,percent of total billed charges,75% of total billed charges ,172.4,80,,,percent of total billed charges,80% of total billed charges ,52.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,108.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,161.63,75,,,percent of total billed charges,75% of total billed charges ,52.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,57.88,26.86,,,percent of total billed charges,26.86% of total billed charges,51.72,24,,,percent of total billed charges,24% of total billed charges ,67.24,31.2,,,percent of total billed charges,31.2% of total billed charges,172.4,80,,,percent of total billed charges,80% of total billed charges,51.72,24,,,percent of total billed charges,24% of total billed charges ,51.72,24,,,percent of total billed charges,24% of total billed charges ,51.72,172.4,
EMESIS BASIN,2500180,CDM,270,RC,,,Outpatient,,,5,2.5,,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,4,80,,,percent of total billed charges,80% of total billed charges ,1.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,2.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.56,31.2,,,percent of total billed charges,31.2% of total billed charges,4,80,,,percent of total billed charges,80% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,4,
SPECIMEN CUP STERILE,2500182,CDM,270,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
URINALS,2500185,CDM,270,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
SITZ BATH,2500197,CDM,270,RC,,,Outpatient,,,96,48,,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,76.8,
SUTURE REM.TRAY,2500200,CDM,272,RC,,,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
STAPLER REM.TRAY,2500201,CDM,272,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
RAZOR,2500202,CDM,270,RC,,,Outpatient,,,10.5,5.25,,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,8.4,80,,,percent of total billed charges,80% of total billed charges ,2.55,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,3.28,31.2,,,percent of total billed charges,31.2% of total billed charges,8.4,80,,,percent of total billed charges,80% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,8.4,
FACIAL TISSUE,2500216,CDM,270,RC,,,Outpatient,,,5,2.5,,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,4,80,,,percent of total billed charges,80% of total billed charges ,1.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,2.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.56,31.2,,,percent of total billed charges,31.2% of total billed charges,4,80,,,percent of total billed charges,80% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,4,
SAFETY SCALPEL 10,2500222,CDM,270,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
SAFETY SCALPEL 11,2500223,CDM,270,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
SAFETY SCALPEL 15,2500224,CDM,270,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
PENROSE DRAIN.25,2500227,CDM,272,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
PENROSE DRAIN.50,2500228,CDM,272,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
PENROSE DRAIN 075,2500229,CDM,272,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
PENROSE DRAIN 1.0,2500230,CDM,272,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
SUSPENSORY MD,2500236,CDM,270,RC,,,Outpatient,,,22.5,11.25,,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,18,
SUSPENSORY  LG,2500237,CDM,270,RC,,,Outpatient,,,22.5,11.25,,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,18,
SUSPENSORY XL,2500238,CDM,270,RC,,,Outpatient,,,22.5,11.25,,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,18,
URINE TOILET MEASURE,2500244,CDM,270,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
DISP. VAGINAL SPECULUM,2500250,CDM,270,RC,,,Outpatient,,,85.5,42.75,,22.97,26.86,,,percent of total billed charges,26.86% of total billed charges,64.13,75,,,percent of total billed charges,75% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,20.52,24,,,percent of total billed charges,24% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,68.4,80,,,percent of total billed charges,80% of total billed charges ,20.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,43.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,20.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.97,26.86,,,percent of total billed charges,26.86% of total billed charges,20.52,24,,,percent of total billed charges,24% of total billed charges ,26.68,31.2,,,percent of total billed charges,31.2% of total billed charges,68.4,80,,,percent of total billed charges,80% of total billed charges,20.52,24,,,percent of total billed charges,24% of total billed charges ,20.52,24,,,percent of total billed charges,24% of total billed charges ,20.52,68.4,
DONUT CUSHION,2500251,CDM,270,RC,,,Outpatient,,,63,31.5,,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,50.4,
WAFER SURFIT 1.25,2500252,CDM,270,RC,,,Outpatient,,,41,20.5,,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,32.8,80,,,percent of total billed charges,80% of total billed charges ,9.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,10.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,12.79,31.2,,,percent of total billed charges,31.2% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,32.8,
WAFER 1.50,2500253,CDM,270,RC,,,Outpatient,,,41,20.5,,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,32.8,80,,,percent of total billed charges,80% of total billed charges ,9.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,10.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,12.79,31.2,,,percent of total billed charges,31.2% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,32.8,
WAFER 1.75,2500254,CDM,270,RC,,,Outpatient,,,41,20.5,,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,32.8,80,,,percent of total billed charges,80% of total billed charges ,9.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,10.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,12.79,31.2,,,percent of total billed charges,31.2% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,32.8,
WAFER 2.25,2500255,CDM,270,RC,,,Outpatient,,,41,20.5,,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,32.8,80,,,percent of total billed charges,80% of total billed charges ,9.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,10.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,12.79,31.2,,,percent of total billed charges,31.2% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,32.8,
WAFER 2.75,2500256,CDM,270,RC,,,Outpatient,,,41,20.5,,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,32.8,80,,,percent of total billed charges,80% of total billed charges ,9.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,10.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,12.79,31.2,,,percent of total billed charges,31.2% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,32.8,
DRAINBAG 1.25,2500257,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
DRAIN BAG 1.50,2500258,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
DRAINBAG  1.75,2500259,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
DRAIN BAG 2.25,2500260,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
DRAIN BAG 2.75,2500261,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
URINE FILTER,2500262,CDM,270,RC,,,Outpatient,,,8,4,,2.15,26.86,,,percent of total billed charges,26.86% of total billed charges,6,75,,,percent of total billed charges,75% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,6.4,80,,,percent of total billed charges,80% of total billed charges ,1.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.15,26.86,,,percent of total billed charges,26.86% of total billed charges,1.92,24,,,percent of total billed charges,24% of total billed charges ,2.5,31.2,,,percent of total billed charges,31.2% of total billed charges,6.4,80,,,percent of total billed charges,80% of total billed charges,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,6.4,
GASTRIC LAVAGE,2500263,CDM,270,RC,,,Outpatient,,,90.5,45.25,,24.31,26.86,,,percent of total billed charges,26.86% of total billed charges,67.88,75,,,percent of total billed charges,75% of total billed charges ,67.88,75,,,percent of total billed charges,75% of total billed charges ,21.72,24,,,percent of total billed charges,24% of total billed charges ,67.88,75,,,percent of total billed charges,75% of total billed charges ,67.88,75,,,percent of total billed charges,75% of total billed charges ,72.4,80,,,percent of total billed charges,80% of total billed charges ,21.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,45.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,67.88,75,,,percent of total billed charges,75% of total billed charges ,22.15,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.31,26.86,,,percent of total billed charges,26.86% of total billed charges,21.72,24,,,percent of total billed charges,24% of total billed charges ,28.24,31.2,,,percent of total billed charges,31.2% of total billed charges,72.4,80,,,percent of total billed charges,80% of total billed charges,21.72,24,,,percent of total billed charges,24% of total billed charges ,21.72,24,,,percent of total billed charges,24% of total billed charges ,21.72,72.4,
NUGAUZE PACKING 1/2,2500264,CDM,270,RC,,,Outpatient,,,48.5,24.25,,13.03,26.86,,,percent of total billed charges,26.86% of total billed charges,36.38,75,,,percent of total billed charges,75% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,38.8,80,,,percent of total billed charges,80% of total billed charges ,11.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.03,26.86,,,percent of total billed charges,26.86% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,15.13,31.2,,,percent of total billed charges,31.2% of total billed charges,38.8,80,,,percent of total billed charges,80% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,38.8,
NUGAUZE 1,2500265,CDM,270,RC,,,Outpatient,,,56.5,28.25,,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
NUGAUZE IDOFORM.50,2500267,CDM,270,RC,,,Outpatient,,,56.5,28.25,,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
NUGAUZE IODOFORM 1,2500268,CDM,270,RC,,,Outpatient,,,143,71.5,,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,114.4,80,,,percent of total billed charges,80% of total billed charges ,34.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,35.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,44.62,31.2,,,percent of total billed charges,31.2% of total billed charges,114.4,80,,,percent of total billed charges,80% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,114.4,
SUTURE STRIP .25,2500270,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
SUTURE STRIP .50,2500271,CDM,270,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
STERI-STRIP .25,2500272,CDM,270,RC,,,Outpatient,,,43.5,21.75,,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,34.8,80,,,percent of total billed charges,80% of total billed charges ,10.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,10.44,24,,,percent of total billed charges,24% of total billed charges ,13.57,31.2,,,percent of total billed charges,31.2% of total billed charges,34.8,80,,,percent of total billed charges,80% of total billed charges,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,34.8,
STERI-STRIP .50,2500273,CDM,270,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
OPSITE 10X5.50,2500274,CDM,270,RC,,,Outpatient,,,165,82.5,,44.32,26.86,,,percent of total billed charges,26.86% of total billed charges,123.75,75,,,percent of total billed charges,75% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,39.6,24,,,percent of total billed charges,24% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,132,80,,,percent of total billed charges,80% of total billed charges ,40,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,40.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,44.32,26.86,,,percent of total billed charges,26.86% of total billed charges,39.6,24,,,percent of total billed charges,24% of total billed charges ,51.48,31.2,,,percent of total billed charges,31.2% of total billed charges,132,80,,,percent of total billed charges,80% of total billed charges,39.6,24,,,percent of total billed charges,24% of total billed charges ,39.6,24,,,percent of total billed charges,24% of total billed charges ,39.6,132,
OPSITE 4X5.50,2500275,CDM,270,RC,,,Outpatient,,,57.5,28.75,,15.44,26.86,,,percent of total billed charges,26.86% of total billed charges,43.13,75,,,percent of total billed charges,75% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,13.8,24,,,percent of total billed charges,24% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,46,80,,,percent of total billed charges,80% of total billed charges ,13.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,14.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.44,26.86,,,percent of total billed charges,26.86% of total billed charges,13.8,24,,,percent of total billed charges,24% of total billed charges ,17.94,31.2,,,percent of total billed charges,31.2% of total billed charges,46,80,,,percent of total billed charges,80% of total billed charges,13.8,24,,,percent of total billed charges,24% of total billed charges ,13.8,24,,,percent of total billed charges,24% of total billed charges ,13.8,46,
VASELINE GAUZE 3X9,2500276,CDM,270,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
XEROFORM 5X9,2500277,CDM,270,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
XEROFORM 4X4,2500278,CDM,270,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
IRRIGATION TRAY,2500280,CDM,270,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
IRRIGATION TRAY PISTON,2500281,CDM,270,RC,,,Outpatient,,,57.5,28.75,,15.44,26.86,,,percent of total billed charges,26.86% of total billed charges,43.13,75,,,percent of total billed charges,75% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,13.8,24,,,percent of total billed charges,24% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,46,80,,,percent of total billed charges,80% of total billed charges ,13.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,14.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.44,26.86,,,percent of total billed charges,26.86% of total billed charges,13.8,24,,,percent of total billed charges,24% of total billed charges ,17.94,31.2,,,percent of total billed charges,31.2% of total billed charges,46,80,,,percent of total billed charges,80% of total billed charges,13.8,24,,,percent of total billed charges,24% of total billed charges ,13.8,24,,,percent of total billed charges,24% of total billed charges ,13.8,46,
DUODERM 4X4,2500283,CDM,272,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
DUODERM 8X8,2500284,CDM,272,RC,,,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,41.2,
TELFA 3X8 NON-ADH,2500287,CDM,270,RC,,,Outpatient,,,6,3,,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.8,80,,,percent of total billed charges,80% of total billed charges ,1.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.87,31.2,,,percent of total billed charges,31.2% of total billed charges,4.8,80,,,percent of total billed charges,80% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,4.8,
TELFA 3X4 NON-ADH.,2500288,CDM,270,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
TELFA  4X8 ADH,2500289,CDM,270,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
UROMETER,2500291,CDM,272,RC,,,Outpatient,,,224.5,112.25,,60.3,26.86,,,percent of total billed charges,26.86% of total billed charges,168.38,75,,,percent of total billed charges,75% of total billed charges ,168.38,75,,,percent of total billed charges,75% of total billed charges ,53.88,24,,,percent of total billed charges,24% of total billed charges ,168.38,75,,,percent of total billed charges,75% of total billed charges ,168.38,75,,,percent of total billed charges,75% of total billed charges ,179.6,80,,,percent of total billed charges,80% of total billed charges ,54.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,113.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,168.38,75,,,percent of total billed charges,75% of total billed charges ,54.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,60.3,26.86,,,percent of total billed charges,26.86% of total billed charges,53.88,24,,,percent of total billed charges,24% of total billed charges ,70.04,31.2,,,percent of total billed charges,31.2% of total billed charges,179.6,80,,,percent of total billed charges,80% of total billed charges,53.88,24,,,percent of total billed charges,24% of total billed charges ,53.88,24,,,percent of total billed charges,24% of total billed charges ,53.88,179.6,
FLATUS BAG,2500292,CDM,270,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
FECAL INCONT.COLLECTION,2500293,CDM,270,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
RAYTEC SPONGE,2500294,CDM,270,RC,,,Outpatient,,,93.5,46.75,,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,74.8,80,,,percent of total billed charges,80% of total billed charges ,22.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,29.17,31.2,,,percent of total billed charges,31.2% of total billed charges,74.8,80,,,percent of total billed charges,80% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,74.8,
YANKAUER SUCTION,2500296,CDM,270,RC,,,Outpatient,,,181.5,90.75,,48.75,26.86,,,percent of total billed charges,26.86% of total billed charges,136.13,75,,,percent of total billed charges,75% of total billed charges ,136.13,75,,,percent of total billed charges,75% of total billed charges ,43.56,24,,,percent of total billed charges,24% of total billed charges ,136.13,75,,,percent of total billed charges,75% of total billed charges ,136.13,75,,,percent of total billed charges,75% of total billed charges ,145.2,80,,,percent of total billed charges,80% of total billed charges ,44,24.24,,,percent of total billed charges,24.24% of total billed charges ,91.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,136.13,75,,,percent of total billed charges,75% of total billed charges ,44.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,48.75,26.86,,,percent of total billed charges,26.86% of total billed charges,43.56,24,,,percent of total billed charges,24% of total billed charges ,56.63,31.2,,,percent of total billed charges,31.2% of total billed charges,145.2,80,,,percent of total billed charges,80% of total billed charges,43.56,24,,,percent of total billed charges,24% of total billed charges ,43.56,24,,,percent of total billed charges,24% of total billed charges ,43.56,145.2,
YANK.SUCTION W/TUBING,2500297,CDM,270,RC,,,Outpatient,,,181.5,90.75,,48.75,26.86,,,percent of total billed charges,26.86% of total billed charges,136.13,75,,,percent of total billed charges,75% of total billed charges ,136.13,75,,,percent of total billed charges,75% of total billed charges ,43.56,24,,,percent of total billed charges,24% of total billed charges ,136.13,75,,,percent of total billed charges,75% of total billed charges ,136.13,75,,,percent of total billed charges,75% of total billed charges ,145.2,80,,,percent of total billed charges,80% of total billed charges ,44,24.24,,,percent of total billed charges,24.24% of total billed charges ,91.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,136.13,75,,,percent of total billed charges,75% of total billed charges ,44.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,48.75,26.86,,,percent of total billed charges,26.86% of total billed charges,43.56,24,,,percent of total billed charges,24% of total billed charges ,56.63,31.2,,,percent of total billed charges,31.2% of total billed charges,145.2,80,,,percent of total billed charges,80% of total billed charges,43.56,24,,,percent of total billed charges,24% of total billed charges ,43.56,24,,,percent of total billed charges,24% of total billed charges ,43.56,145.2,
DRAPE SHEET,2500299,CDM,272,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
STOPCOCK 3-WAY,2500309,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
SURG.GLOVES ALOE-TOUCH 61/,2500312,CDM,272,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
SURG.GLOVES ALOETOUCH 7,2500313,CDM,272,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
SURG.GLOVES ALOETOUCH 7.5,2500314,CDM,272,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
SURG.GLOVES ALOETOUCH 8.0,2500315,CDM,272,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
SURG.GLOVES 81/2,2500316,CDM,272,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
SKIN STAPLER,2500323,CDM,272,RC,,,Outpatient,,,974.5,487.25,,261.75,26.86,,,percent of total billed charges,26.86% of total billed charges,730.88,75,,,percent of total billed charges,75% of total billed charges ,730.88,75,,,percent of total billed charges,75% of total billed charges ,233.88,24,,,percent of total billed charges,24% of total billed charges ,730.88,75,,,percent of total billed charges,75% of total billed charges ,730.88,75,,,percent of total billed charges,75% of total billed charges ,779.6,80,,,percent of total billed charges,80% of total billed charges ,236.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,491.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,730.88,75,,,percent of total billed charges,75% of total billed charges ,238.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,261.75,26.86,,,percent of total billed charges,26.86% of total billed charges,233.88,24,,,percent of total billed charges,24% of total billed charges ,304.04,31.2,,,percent of total billed charges,31.2% of total billed charges,779.6,80,,,percent of total billed charges,80% of total billed charges,233.88,24,,,percent of total billed charges,24% of total billed charges ,233.88,24,,,percent of total billed charges,24% of total billed charges ,233.88,779.6,
FENESTRATED TOWEL,2500333,CDM,270,RC,,,Outpatient,,,5,2.5,,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,4,80,,,percent of total billed charges,80% of total billed charges ,1.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,2.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.56,31.2,,,percent of total billed charges,31.2% of total billed charges,4,80,,,percent of total billed charges,80% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,4,
NONFENESTRATED TOWEL,2500334,CDM,270,RC,,,Outpatient,,,5,2.5,,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,4,80,,,percent of total billed charges,80% of total billed charges ,1.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,2.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.56,31.2,,,percent of total billed charges,31.2% of total billed charges,4,80,,,percent of total billed charges,80% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,4,
ANKLE BRACE SM,2500372,CDM,270,RC,,,Outpatient,,,171,85.5,,45.93,26.86,,,percent of total billed charges,26.86% of total billed charges,128.25,75,,,percent of total billed charges,75% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,41.04,24,,,percent of total billed charges,24% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,136.8,80,,,percent of total billed charges,80% of total billed charges ,41.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,86.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,41.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,45.93,26.86,,,percent of total billed charges,26.86% of total billed charges,41.04,24,,,percent of total billed charges,24% of total billed charges ,53.35,31.2,,,percent of total billed charges,31.2% of total billed charges,136.8,80,,,percent of total billed charges,80% of total billed charges,41.04,24,,,percent of total billed charges,24% of total billed charges ,41.04,24,,,percent of total billed charges,24% of total billed charges ,41.04,136.8,
ANKLE BRACE MED,2500373,CDM,270,RC,,,Outpatient,,,171,85.5,,45.93,26.86,,,percent of total billed charges,26.86% of total billed charges,128.25,75,,,percent of total billed charges,75% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,41.04,24,,,percent of total billed charges,24% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,136.8,80,,,percent of total billed charges,80% of total billed charges ,41.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,86.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,41.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,45.93,26.86,,,percent of total billed charges,26.86% of total billed charges,41.04,24,,,percent of total billed charges,24% of total billed charges ,53.35,31.2,,,percent of total billed charges,31.2% of total billed charges,136.8,80,,,percent of total billed charges,80% of total billed charges,41.04,24,,,percent of total billed charges,24% of total billed charges ,41.04,24,,,percent of total billed charges,24% of total billed charges ,41.04,136.8,
ANKLE BRACE LG,2500374,CDM,270,RC,,,Outpatient,,,171,85.5,,45.93,26.86,,,percent of total billed charges,26.86% of total billed charges,128.25,75,,,percent of total billed charges,75% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,41.04,24,,,percent of total billed charges,24% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,136.8,80,,,percent of total billed charges,80% of total billed charges ,41.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,86.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,128.25,75,,,percent of total billed charges,75% of total billed charges ,41.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,45.93,26.86,,,percent of total billed charges,26.86% of total billed charges,41.04,24,,,percent of total billed charges,24% of total billed charges ,53.35,31.2,,,percent of total billed charges,31.2% of total billed charges,136.8,80,,,percent of total billed charges,80% of total billed charges,41.04,24,,,percent of total billed charges,24% of total billed charges ,41.04,24,,,percent of total billed charges,24% of total billed charges ,41.04,136.8,
KNEE HIGH SM,2500375,CDM,270,RC,,,Outpatient,,,162.5,81.25,,43.65,26.86,,,percent of total billed charges,26.86% of total billed charges,121.88,75,,,percent of total billed charges,75% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,39,24,,,percent of total billed charges,24% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,130,80,,,percent of total billed charges,80% of total billed charges ,39.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,81.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,39.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,43.65,26.86,,,percent of total billed charges,26.86% of total billed charges,39,24,,,percent of total billed charges,24% of total billed charges ,50.7,31.2,,,percent of total billed charges,31.2% of total billed charges,130,80,,,percent of total billed charges,80% of total billed charges,39,24,,,percent of total billed charges,24% of total billed charges ,39,24,,,percent of total billed charges,24% of total billed charges ,39,130,
KNEE HIGH MED,2500376,CDM,270,RC,,,Outpatient,,,162.5,81.25,,43.65,26.86,,,percent of total billed charges,26.86% of total billed charges,121.88,75,,,percent of total billed charges,75% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,39,24,,,percent of total billed charges,24% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,130,80,,,percent of total billed charges,80% of total billed charges ,39.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,81.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,39.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,43.65,26.86,,,percent of total billed charges,26.86% of total billed charges,39,24,,,percent of total billed charges,24% of total billed charges ,50.7,31.2,,,percent of total billed charges,31.2% of total billed charges,130,80,,,percent of total billed charges,80% of total billed charges,39,24,,,percent of total billed charges,24% of total billed charges ,39,24,,,percent of total billed charges,24% of total billed charges ,39,130,
KNEE HIGH LG,2500377,CDM,270,RC,,,Outpatient,,,162.5,81.25,,43.65,26.86,,,percent of total billed charges,26.86% of total billed charges,121.88,75,,,percent of total billed charges,75% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,39,24,,,percent of total billed charges,24% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,130,80,,,percent of total billed charges,80% of total billed charges ,39.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,81.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,39.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,43.65,26.86,,,percent of total billed charges,26.86% of total billed charges,39,24,,,percent of total billed charges,24% of total billed charges ,50.7,31.2,,,percent of total billed charges,31.2% of total billed charges,130,80,,,percent of total billed charges,80% of total billed charges,39,24,,,percent of total billed charges,24% of total billed charges ,39,24,,,percent of total billed charges,24% of total billed charges ,39,130,
KNEE HIGH XL,2500378,CDM,270,RC,,,Outpatient,,,162.5,81.25,,43.65,26.86,,,percent of total billed charges,26.86% of total billed charges,121.88,75,,,percent of total billed charges,75% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,39,24,,,percent of total billed charges,24% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,130,80,,,percent of total billed charges,80% of total billed charges ,39.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,81.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,39.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,43.65,26.86,,,percent of total billed charges,26.86% of total billed charges,39,24,,,percent of total billed charges,24% of total billed charges ,50.7,31.2,,,percent of total billed charges,31.2% of total billed charges,130,80,,,percent of total billed charges,80% of total billed charges,39,24,,,percent of total billed charges,24% of total billed charges ,39,24,,,percent of total billed charges,24% of total billed charges ,39,130,
THIGH HIGH SM,2500379,CDM,270,RC,,,Outpatient,,,121.5,60.75,,32.63,26.86,,,percent of total billed charges,26.86% of total billed charges,91.13,75,,,percent of total billed charges,75% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,97.2,80,,,percent of total billed charges,80% of total billed charges ,29.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.63,26.86,,,percent of total billed charges,26.86% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,37.91,31.2,,,percent of total billed charges,31.2% of total billed charges,97.2,80,,,percent of total billed charges,80% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,97.2,
THIGH HIGH MED,2500380,CDM,270,RC,,,Outpatient,,,121.5,60.75,,32.63,26.86,,,percent of total billed charges,26.86% of total billed charges,91.13,75,,,percent of total billed charges,75% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,97.2,80,,,percent of total billed charges,80% of total billed charges ,29.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.63,26.86,,,percent of total billed charges,26.86% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,37.91,31.2,,,percent of total billed charges,31.2% of total billed charges,97.2,80,,,percent of total billed charges,80% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,97.2,
THIGH HIGH LG,2500381,CDM,270,RC,,,Outpatient,,,121.5,60.75,,32.63,26.86,,,percent of total billed charges,26.86% of total billed charges,91.13,75,,,percent of total billed charges,75% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,97.2,80,,,percent of total billed charges,80% of total billed charges ,29.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.63,26.86,,,percent of total billed charges,26.86% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,37.91,31.2,,,percent of total billed charges,31.2% of total billed charges,97.2,80,,,percent of total billed charges,80% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,97.2,
THIGH HIGH XL,2500382,CDM,270,RC,,,Outpatient,,,275,137.5,,73.87,26.86,,,percent of total billed charges,26.86% of total billed charges,206.25,75,,,percent of total billed charges,75% of total billed charges ,206.25,75,,,percent of total billed charges,75% of total billed charges ,66,24,,,percent of total billed charges,24% of total billed charges ,206.25,75,,,percent of total billed charges,75% of total billed charges ,206.25,75,,,percent of total billed charges,75% of total billed charges ,220,80,,,percent of total billed charges,80% of total billed charges ,66.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,138.6,50.4,,,percent of total billed charges,50.4% of total billed charges ,206.25,75,,,percent of total billed charges,75% of total billed charges ,67.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.87,26.86,,,percent of total billed charges,26.86% of total billed charges,66,24,,,percent of total billed charges,24% of total billed charges ,85.8,31.2,,,percent of total billed charges,31.2% of total billed charges,220,80,,,percent of total billed charges,80% of total billed charges,66,24,,,percent of total billed charges,24% of total billed charges ,66,24,,,percent of total billed charges,24% of total billed charges ,66,220,
ZIM-FLEX CAST TAPE 4,2500391,CDM,270,RC,,,Outpatient,,,74,37,,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,55.5,75,,,percent of total billed charges,75% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,59.2,80,,,percent of total billed charges,80% of total billed charges ,17.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,18.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,23.09,31.2,,,percent of total billed charges,31.2% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,59.2,
COBAN 1,2500393,CDM,270,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
COBAN 3,2500395,CDM,270,RC,,,Outpatient,,,63,31.5,,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,50.4,
COBAN 4,2500396,CDM,270,RC,,,Outpatient,,,83.5,41.75,,22.43,26.86,,,percent of total billed charges,26.86% of total billed charges,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.43,26.86,,,percent of total billed charges,26.86% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,66.8,
UNNA BOOT MEDICO PASTE,2500402,CDM,270,RC,,,Outpatient,,,104,52,,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,83.2,80,,,percent of total billed charges,80% of total billed charges ,25.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,25.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,32.45,31.2,,,percent of total billed charges,31.2% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,83.2,
GAIT TRANSFER BELT,2500403,CDM,270,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
BANDAGE ACE 2,2500404,CDM,270,RC,,,Outpatient,,,5,2.5,,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,4,80,,,percent of total billed charges,80% of total billed charges ,1.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,2.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.56,31.2,,,percent of total billed charges,31.2% of total billed charges,4,80,,,percent of total billed charges,80% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,4,
BANDAGE ACE 3,2500405,CDM,270,RC,,,Outpatient,,,7,3.5,,1.88,26.86,,,percent of total billed charges,26.86% of total billed charges,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.6,80,,,percent of total billed charges,80% of total billed charges ,1.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,1.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.88,26.86,,,percent of total billed charges,26.86% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,2.18,31.2,,,percent of total billed charges,31.2% of total billed charges,5.6,80,,,percent of total billed charges,80% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,5.6,
BANDAGE ACE 4,2500406,CDM,270,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
BANDAGE ACE 6,2500407,CDM,270,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
CAST PADDING 2,2500408,CDM,270,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
CAST PADDING 3,2500409,CDM,270,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
CAST PADDING 4,2500410,CDM,270,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
CAST PADDING 5,2500411,CDM,270,RC,,,Outpatient,,,26,13,,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,20.8,
IMPER STOCKINETTE-M,2500414,CDM,270,RC,,,Outpatient,,,42,21,,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,33.6,80,,,percent of total billed charges,80% of total billed charges ,10.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,13.1,31.2,,,percent of total billed charges,31.2% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,33.6,
IMPER STOCKINETTE-LG,2500415,CDM,270,RC,,,Outpatient,,,42,21,,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,33.6,80,,,percent of total billed charges,80% of total billed charges ,10.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,13.1,31.2,,,percent of total billed charges,31.2% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,33.6,
COLLAR SM,2500421,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
COLLAR MD,2500422,CDM,270,RC,,,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
COLLAR LG,2500423,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
COLLAR UNIVERSAL,2500424,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
COLLAR X-LONG,2500425,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
CLAVICAL SPL. S,2500426,CDM,270,RC,,,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,41.2,
CLAVICLE SPL.MD,2500427,CDM,270,RC,,,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,41.2,
CLAVICLE SPL.LG,2500428,CDM,270,RC,,,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,41.2,
CLAVICLE SPL.XL,2500429,CDM,270,RC,,,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,41.2,
SHOULDER WOMEN SM,2500430,CDM,270,RC,,,Outpatient,,,136,68,,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,108.8,80,,,percent of total billed charges,80% of total billed charges ,32.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,33.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,42.43,31.2,,,percent of total billed charges,31.2% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,108.8,
SHOULDER WOMEN MD,2500431,CDM,270,RC,,,Outpatient,,,136,68,,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,108.8,80,,,percent of total billed charges,80% of total billed charges ,32.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,33.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,42.43,31.2,,,percent of total billed charges,31.2% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,108.8,
SHOULDER WOMEN LG,2500432,CDM,270,RC,,,Outpatient,,,136,68,,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,108.8,80,,,percent of total billed charges,80% of total billed charges ,32.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,33.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,42.43,31.2,,,percent of total billed charges,31.2% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,108.8,
SHOULDER BRACE WOMEN XL,2500433,CDM,270,RC,,,Outpatient,,,136,68,,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,108.8,80,,,percent of total billed charges,80% of total billed charges ,32.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,33.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,42.43,31.2,,,percent of total billed charges,31.2% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,108.8,
SHOULDER BRACE MENS SM,2500434,CDM,270,RC,,,Outpatient,,,136,68,,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,108.8,80,,,percent of total billed charges,80% of total billed charges ,32.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,33.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,42.43,31.2,,,percent of total billed charges,31.2% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,108.8,
SHOULDER MENS MD,2500435,CDM,270,RC,,,Outpatient,,,136,68,,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,108.8,80,,,percent of total billed charges,80% of total billed charges ,32.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,33.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,42.43,31.2,,,percent of total billed charges,31.2% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,108.8,
SHOULDER MENS LG,2500436,CDM,270,RC,,,Outpatient,,,136,68,,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,108.8,80,,,percent of total billed charges,80% of total billed charges ,32.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,33.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,42.43,31.2,,,percent of total billed charges,31.2% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,108.8,
SHOULDER BRACE MENS XL,2500437,CDM,270,RC,,,Outpatient,,,136,68,,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,108.8,80,,,percent of total billed charges,80% of total billed charges ,32.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,33.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,42.43,31.2,,,percent of total billed charges,31.2% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,108.8,
PELVIC TRACTION BELT 34-38,2500440,CDM,270,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
PELVIC TRACTION BELT 38-42,2500441,CDM,270,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
PELVIC TRACTION BELT 42-46,2500442,CDM,270,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
PELVIC TRACTION BELT 46-52,2500443,CDM,270,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
POST-OP SHOE YOUTH,2500446,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
POST-OP WOMENS SM,2500447,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
POST-OP WOMENS MD,2500448,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
POST-OP WOMEN LG,2500449,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
POST-OP SHOE MN S,2500450,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
POST-OP SHOE MN MD,2500451,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
POST-OP SHOE MEN LG,2500452,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
POST-OP SHOE MEN XL,2500453,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
CAST SHOE XSM,2500454,CDM,270,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
CAST SHOE SM,2500455,CDM,270,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
CAST SHOE MD,2500456,CDM,270,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
CAST SHOE LG,2500457,CDM,270,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
CAST SHOE XL,2500458,CDM,270,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
CRADLE BOOT,2500459,CDM,270,RC,,,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,41.2,
ABDOMINAL BINDER 9  30-45,2500467,CDM,270,RC,,,Outpatient,,,176,88,,47.27,26.86,,,percent of total billed charges,26.86% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,42.24,24,,,percent of total billed charges,24% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,140.8,80,,,percent of total billed charges,80% of total billed charges ,42.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,88.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,43.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.27,26.86,,,percent of total billed charges,26.86% of total billed charges,42.24,24,,,percent of total billed charges,24% of total billed charges ,54.91,31.2,,,percent of total billed charges,31.2% of total billed charges,140.8,80,,,percent of total billed charges,80% of total billed charges,42.24,24,,,percent of total billed charges,24% of total billed charges ,42.24,24,,,percent of total billed charges,24% of total billed charges ,42.24,140.8,
ABDOMINAL BINDER 12  46-62,2500468,CDM,270,RC,,,Outpatient,,,176,88,,47.27,26.86,,,percent of total billed charges,26.86% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,42.24,24,,,percent of total billed charges,24% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,140.8,80,,,percent of total billed charges,80% of total billed charges ,42.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,88.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,43.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.27,26.86,,,percent of total billed charges,26.86% of total billed charges,42.24,24,,,percent of total billed charges,24% of total billed charges ,54.91,31.2,,,percent of total billed charges,31.2% of total billed charges,140.8,80,,,percent of total billed charges,80% of total billed charges,42.24,24,,,percent of total billed charges,24% of total billed charges ,42.24,24,,,percent of total billed charges,24% of total billed charges ,42.24,140.8,
ABDOMNIAL BINDER 46-62 9,2500469,CDM,270,RC,,,Outpatient,,,176,88,,47.27,26.86,,,percent of total billed charges,26.86% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,42.24,24,,,percent of total billed charges,24% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,140.8,80,,,percent of total billed charges,80% of total billed charges ,42.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,88.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,43.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.27,26.86,,,percent of total billed charges,26.86% of total billed charges,42.24,24,,,percent of total billed charges,24% of total billed charges ,54.91,31.2,,,percent of total billed charges,31.2% of total billed charges,140.8,80,,,percent of total billed charges,80% of total billed charges,42.24,24,,,percent of total billed charges,24% of total billed charges ,42.24,24,,,percent of total billed charges,24% of total billed charges ,42.24,140.8,
ABDOMINAL BINDER 30-45 12,2500470,CDM,270,RC,,,Outpatient,,,176,88,,47.27,26.86,,,percent of total billed charges,26.86% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,42.24,24,,,percent of total billed charges,24% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,140.8,80,,,percent of total billed charges,80% of total billed charges ,42.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,88.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,43.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.27,26.86,,,percent of total billed charges,26.86% of total billed charges,42.24,24,,,percent of total billed charges,24% of total billed charges ,54.91,31.2,,,percent of total billed charges,31.2% of total billed charges,140.8,80,,,percent of total billed charges,80% of total billed charges,42.24,24,,,percent of total billed charges,24% of total billed charges ,42.24,24,,,percent of total billed charges,24% of total billed charges ,42.24,140.8,
ABDOMIBAL BINDER 60-75 IN,2500471,CDM,270,RC,,,Outpatient,,,176,88,,47.27,26.86,,,percent of total billed charges,26.86% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,42.24,24,,,percent of total billed charges,24% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,140.8,80,,,percent of total billed charges,80% of total billed charges ,42.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,88.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,43.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.27,26.86,,,percent of total billed charges,26.86% of total billed charges,42.24,24,,,percent of total billed charges,24% of total billed charges ,54.91,31.2,,,percent of total billed charges,31.2% of total billed charges,140.8,80,,,percent of total billed charges,80% of total billed charges,42.24,24,,,percent of total billed charges,24% of total billed charges ,42.24,24,,,percent of total billed charges,24% of total billed charges ,42.24,140.8,
BIO-PATCH DRESSING,2500472,CDM,272,RC,,,Outpatient,,,121.5,60.75,,32.63,26.86,,,percent of total billed charges,26.86% of total billed charges,91.13,75,,,percent of total billed charges,75% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,97.2,80,,,percent of total billed charges,80% of total billed charges ,29.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.63,26.86,,,percent of total billed charges,26.86% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,37.91,31.2,,,percent of total billed charges,31.2% of total billed charges,97.2,80,,,percent of total billed charges,80% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,97.2,
SURGICEL 2X3,2500474,CDM,272,RC,,,Outpatient,,,138,69,,37.07,26.86,,,percent of total billed charges,26.86% of total billed charges,103.5,75,,,percent of total billed charges,75% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,33.12,24,,,percent of total billed charges,24% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,110.4,80,,,percent of total billed charges,80% of total billed charges ,33.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,69.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,33.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.07,26.86,,,percent of total billed charges,26.86% of total billed charges,33.12,24,,,percent of total billed charges,24% of total billed charges ,43.06,31.2,,,percent of total billed charges,31.2% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,33.12,24,,,percent of total billed charges,24% of total billed charges ,33.12,24,,,percent of total billed charges,24% of total billed charges ,33.12,110.4,
CRUTCHES XLONG 6'6 -7 2,2500479,CDM,270,RC,,,Outpatient,,,79.5,39.75,,21.35,26.86,,,percent of total billed charges,26.86% of total billed charges,59.63,75,,,percent of total billed charges,75% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,19.08,24,,,percent of total billed charges,24% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,63.6,80,,,percent of total billed charges,80% of total billed charges ,19.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,40.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,19.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.35,26.86,,,percent of total billed charges,26.86% of total billed charges,19.08,24,,,percent of total billed charges,24% of total billed charges ,24.8,31.2,,,percent of total billed charges,31.2% of total billed charges,63.6,80,,,percent of total billed charges,80% of total billed charges,19.08,24,,,percent of total billed charges,24% of total billed charges ,19.08,24,,,percent of total billed charges,24% of total billed charges ,19.08,63.6,
CRUTCHES ADULT 5'10 -6'6,2500480,CDM,270,RC,,,Outpatient,,,79.5,39.75,,21.35,26.86,,,percent of total billed charges,26.86% of total billed charges,59.63,75,,,percent of total billed charges,75% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,19.08,24,,,percent of total billed charges,24% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,63.6,80,,,percent of total billed charges,80% of total billed charges ,19.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,40.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,19.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.35,26.86,,,percent of total billed charges,26.86% of total billed charges,19.08,24,,,percent of total billed charges,24% of total billed charges ,24.8,31.2,,,percent of total billed charges,31.2% of total billed charges,63.6,80,,,percent of total billed charges,80% of total billed charges,19.08,24,,,percent of total billed charges,24% of total billed charges ,19.08,24,,,percent of total billed charges,24% of total billed charges ,19.08,63.6,
CRUTCHES ADULT 5'2 TO 5'10,2500481,CDM,270,RC,,,Outpatient,,,179,89.5,,48.08,26.86,,,percent of total billed charges,26.86% of total billed charges,134.25,75,,,percent of total billed charges,75% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,42.96,24,,,percent of total billed charges,24% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,143.2,80,,,percent of total billed charges,80% of total billed charges ,43.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,90.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,43.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,48.08,26.86,,,percent of total billed charges,26.86% of total billed charges,42.96,24,,,percent of total billed charges,24% of total billed charges ,55.85,31.2,,,percent of total billed charges,31.2% of total billed charges,143.2,80,,,percent of total billed charges,80% of total billed charges,42.96,24,,,percent of total billed charges,24% of total billed charges ,42.96,24,,,percent of total billed charges,24% of total billed charges ,42.96,143.2,
CRUTCHES YOUTH 4'6 TO 5'2,2500482,CDM,270,RC,,,Outpatient,,,79.5,39.75,,21.35,26.86,,,percent of total billed charges,26.86% of total billed charges,59.63,75,,,percent of total billed charges,75% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,19.08,24,,,percent of total billed charges,24% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,63.6,80,,,percent of total billed charges,80% of total billed charges ,19.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,40.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,19.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.35,26.86,,,percent of total billed charges,26.86% of total billed charges,19.08,24,,,percent of total billed charges,24% of total billed charges ,24.8,31.2,,,percent of total billed charges,31.2% of total billed charges,63.6,80,,,percent of total billed charges,80% of total billed charges,19.08,24,,,percent of total billed charges,24% of total billed charges ,19.08,24,,,percent of total billed charges,24% of total billed charges ,19.08,63.6,
KNEE IMMOB 16  UNIVERSAL,2500483,CDM,270,RC,,,Outpatient,,,769.5,384.75,,206.69,26.86,,,percent of total billed charges,26.86% of total billed charges,577.13,75,,,percent of total billed charges,75% of total billed charges ,577.13,75,,,percent of total billed charges,75% of total billed charges ,184.68,24,,,percent of total billed charges,24% of total billed charges ,577.13,75,,,percent of total billed charges,75% of total billed charges ,577.13,75,,,percent of total billed charges,75% of total billed charges ,615.6,80,,,percent of total billed charges,80% of total billed charges ,186.53,24.24,,,percent of total billed charges,24.24% of total billed charges ,387.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,577.13,75,,,percent of total billed charges,75% of total billed charges ,188.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,206.69,26.86,,,percent of total billed charges,26.86% of total billed charges,184.68,24,,,percent of total billed charges,24% of total billed charges ,240.08,31.2,,,percent of total billed charges,31.2% of total billed charges,615.6,80,,,percent of total billed charges,80% of total billed charges,184.68,24,,,percent of total billed charges,24% of total billed charges ,184.68,24,,,percent of total billed charges,24% of total billed charges ,184.68,615.6,
KNEE IMMOB 16  MED,2500484,CDM,270,RC,,,Outpatient,,,769.5,384.75,,206.69,26.86,,,percent of total billed charges,26.86% of total billed charges,577.13,75,,,percent of total billed charges,75% of total billed charges ,577.13,75,,,percent of total billed charges,75% of total billed charges ,184.68,24,,,percent of total billed charges,24% of total billed charges ,577.13,75,,,percent of total billed charges,75% of total billed charges ,577.13,75,,,percent of total billed charges,75% of total billed charges ,615.6,80,,,percent of total billed charges,80% of total billed charges ,186.53,24.24,,,percent of total billed charges,24.24% of total billed charges ,387.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,577.13,75,,,percent of total billed charges,75% of total billed charges ,188.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,206.69,26.86,,,percent of total billed charges,26.86% of total billed charges,184.68,24,,,percent of total billed charges,24% of total billed charges ,240.08,31.2,,,percent of total billed charges,31.2% of total billed charges,615.6,80,,,percent of total billed charges,80% of total billed charges,184.68,24,,,percent of total billed charges,24% of total billed charges ,184.68,24,,,percent of total billed charges,24% of total billed charges ,184.68,615.6,
KNEE IMMOB 16  LG,2500485,CDM,270,RC,,,Outpatient,,,342,171,,91.86,26.86,,,percent of total billed charges,26.86% of total billed charges,256.5,75,,,percent of total billed charges,75% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,273.6,80,,,percent of total billed charges,80% of total billed charges ,82.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,172.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,83.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,91.86,26.86,,,percent of total billed charges,26.86% of total billed charges,82.08,24,,,percent of total billed charges,24% of total billed charges ,106.7,31.2,,,percent of total billed charges,31.2% of total billed charges,273.6,80,,,percent of total billed charges,80% of total billed charges,82.08,24,,,percent of total billed charges,24% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,82.08,273.6,
KNEE IMMOB 16 XL,2500486,CDM,270,RC,,,Outpatient,,,342,171,,91.86,26.86,,,percent of total billed charges,26.86% of total billed charges,256.5,75,,,percent of total billed charges,75% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,273.6,80,,,percent of total billed charges,80% of total billed charges ,82.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,172.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,83.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,91.86,26.86,,,percent of total billed charges,26.86% of total billed charges,82.08,24,,,percent of total billed charges,24% of total billed charges ,106.7,31.2,,,percent of total billed charges,31.2% of total billed charges,273.6,80,,,percent of total billed charges,80% of total billed charges,82.08,24,,,percent of total billed charges,24% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,82.08,273.6,
KNEE IMMOB UNIVERSAL 22,2500487,CDM,270,RC,,,Outpatient,,,342,171,,91.86,26.86,,,percent of total billed charges,26.86% of total billed charges,256.5,75,,,percent of total billed charges,75% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,273.6,80,,,percent of total billed charges,80% of total billed charges ,82.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,172.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,83.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,91.86,26.86,,,percent of total billed charges,26.86% of total billed charges,82.08,24,,,percent of total billed charges,24% of total billed charges ,106.7,31.2,,,percent of total billed charges,31.2% of total billed charges,273.6,80,,,percent of total billed charges,80% of total billed charges,82.08,24,,,percent of total billed charges,24% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,82.08,273.6,
KNEE IMMOB 22  MD,2500488,CDM,270,RC,,,Outpatient,,,342,171,,91.86,26.86,,,percent of total billed charges,26.86% of total billed charges,256.5,75,,,percent of total billed charges,75% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,273.6,80,,,percent of total billed charges,80% of total billed charges ,82.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,172.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,83.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,91.86,26.86,,,percent of total billed charges,26.86% of total billed charges,82.08,24,,,percent of total billed charges,24% of total billed charges ,106.7,31.2,,,percent of total billed charges,31.2% of total billed charges,273.6,80,,,percent of total billed charges,80% of total billed charges,82.08,24,,,percent of total billed charges,24% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,82.08,273.6,
KNEE IMMOB 22  LG,2500489,CDM,270,RC,,,Outpatient,,,342,171,,91.86,26.86,,,percent of total billed charges,26.86% of total billed charges,256.5,75,,,percent of total billed charges,75% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,273.6,80,,,percent of total billed charges,80% of total billed charges ,82.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,172.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,83.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,91.86,26.86,,,percent of total billed charges,26.86% of total billed charges,82.08,24,,,percent of total billed charges,24% of total billed charges ,106.7,31.2,,,percent of total billed charges,31.2% of total billed charges,273.6,80,,,percent of total billed charges,80% of total billed charges,82.08,24,,,percent of total billed charges,24% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,82.08,273.6,
KNEE IMMOB 22 XL,2500490,CDM,270,RC,,,Outpatient,,,342,171,,91.86,26.86,,,percent of total billed charges,26.86% of total billed charges,256.5,75,,,percent of total billed charges,75% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,273.6,80,,,percent of total billed charges,80% of total billed charges ,82.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,172.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,83.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,91.86,26.86,,,percent of total billed charges,26.86% of total billed charges,82.08,24,,,percent of total billed charges,24% of total billed charges ,106.7,31.2,,,percent of total billed charges,31.2% of total billed charges,273.6,80,,,percent of total billed charges,80% of total billed charges,82.08,24,,,percent of total billed charges,24% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,82.08,273.6,
DERMABOND,2500494,CDM,270,RC,,,Outpatient,,,109,54.5,,29.28,26.86,,,percent of total billed charges,26.86% of total billed charges,81.75,75,,,percent of total billed charges,75% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,26.16,24,,,percent of total billed charges,24% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,87.2,80,,,percent of total billed charges,80% of total billed charges ,26.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,26.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.28,26.86,,,percent of total billed charges,26.86% of total billed charges,26.16,24,,,percent of total billed charges,24% of total billed charges ,34.01,31.2,,,percent of total billed charges,31.2% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,26.16,24,,,percent of total billed charges,24% of total billed charges ,26.16,24,,,percent of total billed charges,24% of total billed charges ,26.16,87.2,
PELVIC TRACTION BELT,2500496,CDM,270,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
PELVIC TRACTION BELT,2500498,CDM,270,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
2WAY CATH 16FR FOLEY 30CC,2500499,CDM,272,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
2WAY CATH 18FR FOLEY 30CC,2500500,CDM,272,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
2WAY CATH 20FR FOLEY 30CC,2500501,CDM,272,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
2WAY CATH 22FR FOLEY 30CC,2500502,CDM,272,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
2WAY CATH 24FR FOLEY 30CC,2500503,CDM,272,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
2WAY CATH 28FR FOLEY 30CC,2500504,CDM,272,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
2WAY CATH 30FR FOLEY 30CC,2500505,CDM,272,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
3WAY CATH 16FR 30CC,2500506,CDM,272,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
3WAY CATH 18FR 30CC,2500507,CDM,272,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
3WAY CATH 20FR,2500508,CDM,272,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
3WAY CATH 22FR 30CC,2500509,CDM,272,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
3WAY CATH 24FR,2500510,CDM,272,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
3WAY CATH 26FR,2500511,CDM,272,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
2WAY CATH 12FR. FOLEY 5CC,2500512,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
2WAY CATH 14FR 5CC BALLON,2500513,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
2WAY CATH 16FR 5CC BALLON,2500514,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
2WAY CATH 18FR 5CC BALLON,2500515,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
2WAY CATH 20FR 5CC BALLON,2500516,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
2WAY CATH 22FR 5CC BALLON,2500517,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
2WAY CATH 24FR 5CC BALLON,2500518,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
2WAY CATH 26FR 5CC BALLON,2500519,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
2WAY CATH 28FR 5CC BALLON,2500520,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
2WAY CATH 30FR 5CC BALLON,2500521,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
CATH FOLEY 30CC 16FR SILVE,2500522,CDM,272,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
CATH FOLEY 30CC 18FR SILVE,2500523,CDM,272,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
CATH FOLEY 30CC 20FR SILVE,2500524,CDM,272,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
CATH FOLEY 30CC 22FR SILVE,2500525,CDM,272,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
CATH FOLEY 2WAY 30FR 30CC,2500526,CDM,272,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
CATH FOLEY 5CC 28FR SILVER,2500527,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
CATH FOLEY 30CC 30FR SILVE,2500528,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
CATH 22FR 30CC TELFON 3WA,2500529,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
CATH 24FR 30CC TEFLON 3WAY,2500530,CDM,272,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
CATH 16FR 5CC COUDE,2500531,CDM,278,RC,C1758,HCPCS,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,51.5,75,,,percent of total billed charges,75% of total billed charges ,51.5,75,,,percent of total billed charges,75% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,51.5,75,,,percent of total billed charges,75% of total billed charges ,51.5,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,51.5,
CATH 22FR 5CC COUDE,2500532,CDM,278,RC,C1758,HCPCS,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,51.5,75,,,percent of total billed charges,75% of total billed charges ,51.5,75,,,percent of total billed charges,75% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,51.5,75,,,percent of total billed charges,75% of total billed charges ,51.5,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,51.5,
STERILE GUIDE 18GA NEEDLES,2500534,CDM,272,RC,,,Outpatient,,,152.5,76.25,,40.96,26.86,,,percent of total billed charges,26.86% of total billed charges,114.38,75,,,percent of total billed charges,75% of total billed charges ,114.38,75,,,percent of total billed charges,75% of total billed charges ,36.6,24,,,percent of total billed charges,24% of total billed charges ,114.38,75,,,percent of total billed charges,75% of total billed charges ,114.38,75,,,percent of total billed charges,75% of total billed charges ,122,80,,,percent of total billed charges,80% of total billed charges ,36.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,76.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,114.38,75,,,percent of total billed charges,75% of total billed charges ,37.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,40.96,26.86,,,percent of total billed charges,26.86% of total billed charges,36.6,24,,,percent of total billed charges,24% of total billed charges ,47.58,31.2,,,percent of total billed charges,31.2% of total billed charges,122,80,,,percent of total billed charges,80% of total billed charges,36.6,24,,,percent of total billed charges,24% of total billed charges ,36.6,24,,,percent of total billed charges,24% of total billed charges ,36.6,122,
MAX 30 INFLATION,2500536,CDM,272,RC,,,Outpatient,,,293.5,146.75,,78.83,26.86,,,percent of total billed charges,26.86% of total billed charges,220.13,75,,,percent of total billed charges,75% of total billed charges ,220.13,75,,,percent of total billed charges,75% of total billed charges ,70.44,24,,,percent of total billed charges,24% of total billed charges ,220.13,75,,,percent of total billed charges,75% of total billed charges ,220.13,75,,,percent of total billed charges,75% of total billed charges ,234.8,80,,,percent of total billed charges,80% of total billed charges ,71.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,147.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,220.13,75,,,percent of total billed charges,75% of total billed charges ,71.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,78.83,26.86,,,percent of total billed charges,26.86% of total billed charges,70.44,24,,,percent of total billed charges,24% of total billed charges ,91.57,31.2,,,percent of total billed charges,31.2% of total billed charges,234.8,80,,,percent of total billed charges,80% of total billed charges,70.44,24,,,percent of total billed charges,24% of total billed charges ,70.44,24,,,percent of total billed charges,24% of total billed charges ,70.44,234.8,
MUSTANG BALLOON,2500555,CDM,278,RC,C1725,HCPCS,Outpatient,,,1014.5,507.25,,272.49,26.86,,,percent of total billed charges,26.86% of total billed charges,760.88,75,,,percent of total billed charges,75% of total billed charges ,760.88,75,,,percent of total billed charges,75% of total billed charges ,243.48,24,,,percent of total billed charges,24% of total billed charges ,760.88,75,,,percent of total billed charges,75% of total billed charges ,760.88,75,,,percent of total billed charges,75% of total billed charges ,811.6,80,,,percent of total billed charges,80% of total billed charges ,245.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,511.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,760.88,75,,,percent of total billed charges,75% of total billed charges ,248.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,272.49,26.86,,,percent of total billed charges,26.86% of total billed charges,243.48,24,,,percent of total billed charges,24% of total billed charges ,316.52,31.2,,,percent of total billed charges,31.2% of total billed charges,811.6,80,,,percent of total billed charges,80% of total billed charges,243.48,24,,,percent of total billed charges,24% of total billed charges ,243.48,24,,,percent of total billed charges,24% of total billed charges ,243.48,811.6,
BENSON WIRE 180CM,2500556,CDM,272,RC,,,Outpatient,,,136,68,,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,108.8,80,,,percent of total billed charges,80% of total billed charges ,32.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,33.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,42.43,31.2,,,percent of total billed charges,31.2% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,108.8,
WIRE GUIDE 145CM,2500557,CDM,272,RC,,,Outpatient,,,136,68,,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,108.8,80,,,percent of total billed charges,80% of total billed charges ,32.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,33.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,42.43,31.2,,,percent of total billed charges,31.2% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,108.8,
PULSE OXISENSOR ADULT,2500681,CDM,272,RC,,,Outpatient,,,248,124,,66.61,26.86,,,percent of total billed charges,26.86% of total billed charges,186,75,,,percent of total billed charges,75% of total billed charges ,186,75,,,percent of total billed charges,75% of total billed charges ,59.52,24,,,percent of total billed charges,24% of total billed charges ,186,75,,,percent of total billed charges,75% of total billed charges ,186,75,,,percent of total billed charges,75% of total billed charges ,198.4,80,,,percent of total billed charges,80% of total billed charges ,60.12,24.24,,,percent of total billed charges,24.24% of total billed charges ,124.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,186,75,,,percent of total billed charges,75% of total billed charges ,60.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,66.61,26.86,,,percent of total billed charges,26.86% of total billed charges,59.52,24,,,percent of total billed charges,24% of total billed charges ,77.38,31.2,,,percent of total billed charges,31.2% of total billed charges,198.4,80,,,percent of total billed charges,80% of total billed charges,59.52,24,,,percent of total billed charges,24% of total billed charges ,59.52,24,,,percent of total billed charges,24% of total billed charges ,59.52,198.4,
PULSE OXISENSOR PED.,2500682,CDM,270,RC,,,Outpatient,,,215.5,107.75,,57.88,26.86,,,percent of total billed charges,26.86% of total billed charges,161.63,75,,,percent of total billed charges,75% of total billed charges ,161.63,75,,,percent of total billed charges,75% of total billed charges ,51.72,24,,,percent of total billed charges,24% of total billed charges ,161.63,75,,,percent of total billed charges,75% of total billed charges ,161.63,75,,,percent of total billed charges,75% of total billed charges ,172.4,80,,,percent of total billed charges,80% of total billed charges ,52.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,108.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,161.63,75,,,percent of total billed charges,75% of total billed charges ,52.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,57.88,26.86,,,percent of total billed charges,26.86% of total billed charges,51.72,24,,,percent of total billed charges,24% of total billed charges ,67.24,31.2,,,percent of total billed charges,31.2% of total billed charges,172.4,80,,,percent of total billed charges,80% of total billed charges,51.72,24,,,percent of total billed charges,24% of total billed charges ,51.72,24,,,percent of total billed charges,24% of total billed charges ,51.72,172.4,
KNEE SLEEVES SCD LARGE,2500860,CDM,270,RC,,,Outpatient,,,119.5,59.75,,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.1,26.86,,,percent of total billed charges,26.86% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,95.6,
SKIN MARKERS,2500862,CDM,270,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
WARMING BLANKETS-SURGERY,2500863,CDM,270,RC,,,Outpatient,,,126.5,63.25,,33.98,26.86,,,percent of total billed charges,26.86% of total billed charges,94.88,75,,,percent of total billed charges,75% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,30.36,24,,,percent of total billed charges,24% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,101.2,80,,,percent of total billed charges,80% of total billed charges ,30.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,63.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,30.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,33.98,26.86,,,percent of total billed charges,26.86% of total billed charges,30.36,24,,,percent of total billed charges,24% of total billed charges ,39.47,31.2,,,percent of total billed charges,31.2% of total billed charges,101.2,80,,,percent of total billed charges,80% of total billed charges,30.36,24,,,percent of total billed charges,24% of total billed charges ,30.36,24,,,percent of total billed charges,24% of total billed charges ,30.36,101.2,
WARMING BLANKETS-ER/ICU,2500864,CDM,270,RC,,,Outpatient,,,126.5,63.25,,33.98,26.86,,,percent of total billed charges,26.86% of total billed charges,94.88,75,,,percent of total billed charges,75% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,30.36,24,,,percent of total billed charges,24% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,101.2,80,,,percent of total billed charges,80% of total billed charges ,30.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,63.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,30.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,33.98,26.86,,,percent of total billed charges,26.86% of total billed charges,30.36,24,,,percent of total billed charges,24% of total billed charges ,39.47,31.2,,,percent of total billed charges,31.2% of total billed charges,101.2,80,,,percent of total billed charges,80% of total billed charges,30.36,24,,,percent of total billed charges,24% of total billed charges ,30.36,24,,,percent of total billed charges,24% of total billed charges ,30.36,101.2,
ESMARK BANDAGE 4X9,2500866,CDM,270,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
THORACIC CATH STRAIGHT 32F,2500869,CDM,272,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
THORCIC CATH STRAIGHT 28FR,2500870,CDM,272,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
TROCAR CATH 24FR,2500871,CDM,272,RC,,,Outpatient,,,56.5,28.25,,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
TROCAR CATH 32FR,2500872,CDM,272,RC,,,Outpatient,,,56.5,28.25,,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
HYDRA-LAP IRRIGATION,2500885,CDM,270,RC,,,Outpatient,,,359.5,179.75,,96.56,26.86,,,percent of total billed charges,26.86% of total billed charges,269.63,75,,,percent of total billed charges,75% of total billed charges ,269.63,75,,,percent of total billed charges,75% of total billed charges ,86.28,24,,,percent of total billed charges,24% of total billed charges ,269.63,75,,,percent of total billed charges,75% of total billed charges ,269.63,75,,,percent of total billed charges,75% of total billed charges ,287.6,80,,,percent of total billed charges,80% of total billed charges ,87.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,181.19,50.4,,,percent of total billed charges,50.4% of total billed charges ,269.63,75,,,percent of total billed charges,75% of total billed charges ,88.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,96.56,26.86,,,percent of total billed charges,26.86% of total billed charges,86.28,24,,,percent of total billed charges,24% of total billed charges ,112.16,31.2,,,percent of total billed charges,31.2% of total billed charges,287.6,80,,,percent of total billed charges,80% of total billed charges,86.28,24,,,percent of total billed charges,24% of total billed charges ,86.28,24,,,percent of total billed charges,24% of total billed charges ,86.28,287.6,
COBAN STERILE 4,2500886,CDM,270,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
WALKING BOOT PNEUMATIC MED,2500889,CDM,270,RC,,,Outpatient,,,364.5,182.25,,97.9,26.86,,,percent of total billed charges,26.86% of total billed charges,273.38,75,,,percent of total billed charges,75% of total billed charges ,273.38,75,,,percent of total billed charges,75% of total billed charges ,87.48,24,,,percent of total billed charges,24% of total billed charges ,273.38,75,,,percent of total billed charges,75% of total billed charges ,273.38,75,,,percent of total billed charges,75% of total billed charges ,291.6,80,,,percent of total billed charges,80% of total billed charges ,88.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,183.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,273.38,75,,,percent of total billed charges,75% of total billed charges ,89.23,24.48,,,percent of total billed charges,24.48% of total billed charges ,97.9,26.86,,,percent of total billed charges,26.86% of total billed charges,87.48,24,,,percent of total billed charges,24% of total billed charges ,113.72,31.2,,,percent of total billed charges,31.2% of total billed charges,291.6,80,,,percent of total billed charges,80% of total billed charges,87.48,24,,,percent of total billed charges,24% of total billed charges ,87.48,24,,,percent of total billed charges,24% of total billed charges ,87.48,291.6,
WALKING BOOT PNEUMATIC LG.,2500890,CDM,270,RC,,,Outpatient,,,364.5,182.25,,97.9,26.86,,,percent of total billed charges,26.86% of total billed charges,273.38,75,,,percent of total billed charges,75% of total billed charges ,273.38,75,,,percent of total billed charges,75% of total billed charges ,87.48,24,,,percent of total billed charges,24% of total billed charges ,273.38,75,,,percent of total billed charges,75% of total billed charges ,273.38,75,,,percent of total billed charges,75% of total billed charges ,291.6,80,,,percent of total billed charges,80% of total billed charges ,88.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,183.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,273.38,75,,,percent of total billed charges,75% of total billed charges ,89.23,24.48,,,percent of total billed charges,24.48% of total billed charges ,97.9,26.86,,,percent of total billed charges,26.86% of total billed charges,87.48,24,,,percent of total billed charges,24% of total billed charges ,113.72,31.2,,,percent of total billed charges,31.2% of total billed charges,291.6,80,,,percent of total billed charges,80% of total billed charges,87.48,24,,,percent of total billed charges,24% of total billed charges ,87.48,24,,,percent of total billed charges,24% of total billed charges ,87.48,291.6,
WALKING BOOT PNEUMATIC SM.,2500891,CDM,270,RC,,,Outpatient,,,364.5,182.25,,97.9,26.86,,,percent of total billed charges,26.86% of total billed charges,273.38,75,,,percent of total billed charges,75% of total billed charges ,273.38,75,,,percent of total billed charges,75% of total billed charges ,87.48,24,,,percent of total billed charges,24% of total billed charges ,273.38,75,,,percent of total billed charges,75% of total billed charges ,273.38,75,,,percent of total billed charges,75% of total billed charges ,291.6,80,,,percent of total billed charges,80% of total billed charges ,88.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,183.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,273.38,75,,,percent of total billed charges,75% of total billed charges ,89.23,24.48,,,percent of total billed charges,24.48% of total billed charges ,97.9,26.86,,,percent of total billed charges,26.86% of total billed charges,87.48,24,,,percent of total billed charges,24% of total billed charges ,113.72,31.2,,,percent of total billed charges,31.2% of total billed charges,291.6,80,,,percent of total billed charges,80% of total billed charges,87.48,24,,,percent of total billed charges,24% of total billed charges ,87.48,24,,,percent of total billed charges,24% of total billed charges ,87.48,291.6,
MAHYRKAR DUAL 6TH 11.5FR,2500904,CDM,278,RC,C1751,HCPCS,Outpatient,,,360.5,180.25,,96.83,26.86,,,percent of total billed charges,26.86% of total billed charges,360.5,75,,,percent of total billed charges,75% of total billed charges ,360.5,75,,,percent of total billed charges,75% of total billed charges ,86.52,24,,,percent of total billed charges,24% of total billed charges ,360.5,75,,,percent of total billed charges,75% of total billed charges ,360.5,75,,,percent of total billed charges,75% of total billed charges ,288.4,80,,,percent of total billed charges,80% of total billed charges ,87.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,181.69,50.4,,,percent of total billed charges,50.4% of total billed charges ,270.38,75,,,percent of total billed charges,75% of total billed charges ,88.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,96.83,26.86,,,percent of total billed charges,26.86% of total billed charges,86.52,24,,,percent of total billed charges,24% of total billed charges ,112.48,31.2,,,percent of total billed charges,31.2% of total billed charges,288.4,80,,,percent of total billed charges,80% of total billed charges,86.52,24,,,percent of total billed charges,24% of total billed charges ,86.52,24,,,percent of total billed charges,24% of total billed charges ,86.52,360.5,
HARMONIC SCAL  HAR36,2500923,CDM,270,RC,,,Outpatient,,,1422.5,711.25,,382.08,26.86,,,percent of total billed charges,26.86% of total billed charges,1066.88,75,,,percent of total billed charges,75% of total billed charges ,1066.88,75,,,percent of total billed charges,75% of total billed charges ,341.4,24,,,percent of total billed charges,24% of total billed charges ,1066.88,75,,,percent of total billed charges,75% of total billed charges ,1066.88,75,,,percent of total billed charges,75% of total billed charges ,1138,80,,,percent of total billed charges,80% of total billed charges ,344.81,24.24,,,percent of total billed charges,24.24% of total billed charges ,716.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,1066.88,75,,,percent of total billed charges,75% of total billed charges ,348.23,24.48,,,percent of total billed charges,24.48% of total billed charges ,382.08,26.86,,,percent of total billed charges,26.86% of total billed charges,341.4,24,,,percent of total billed charges,24% of total billed charges ,443.82,31.2,,,percent of total billed charges,31.2% of total billed charges,1138,80,,,percent of total billed charges,80% of total billed charges,341.4,24,,,percent of total billed charges,24% of total billed charges ,341.4,24,,,percent of total billed charges,24% of total billed charges ,341.4,1138,
LIGACLIP MCA 5M  MCS20,2500925,CDM,272,RC,,,Outpatient,,,408,204,,109.59,26.86,,,percent of total billed charges,26.86% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges ,306,75,,,percent of total billed charges,75% of total billed charges ,97.92,24,,,percent of total billed charges,24% of total billed charges ,306,75,,,percent of total billed charges,75% of total billed charges ,306,75,,,percent of total billed charges,75% of total billed charges ,326.4,80,,,percent of total billed charges,80% of total billed charges ,98.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,205.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,306,75,,,percent of total billed charges,75% of total billed charges ,99.88,24.48,,,percent of total billed charges,24.48% of total billed charges ,109.59,26.86,,,percent of total billed charges,26.86% of total billed charges,97.92,24,,,percent of total billed charges,24% of total billed charges ,127.3,31.2,,,percent of total billed charges,31.2% of total billed charges,326.4,80,,,percent of total billed charges,80% of total billed charges,97.92,24,,,percent of total billed charges,24% of total billed charges ,97.92,24,,,percent of total billed charges,24% of total billed charges ,97.92,326.4,
LIGACLIP MCM20,2500926,CDM,272,RC,,,Outpatient,,,408,204,,109.59,26.86,,,percent of total billed charges,26.86% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges ,306,75,,,percent of total billed charges,75% of total billed charges ,97.92,24,,,percent of total billed charges,24% of total billed charges ,306,75,,,percent of total billed charges,75% of total billed charges ,306,75,,,percent of total billed charges,75% of total billed charges ,326.4,80,,,percent of total billed charges,80% of total billed charges ,98.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,205.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,306,75,,,percent of total billed charges,75% of total billed charges ,99.88,24.48,,,percent of total billed charges,24.48% of total billed charges ,109.59,26.86,,,percent of total billed charges,26.86% of total billed charges,97.92,24,,,percent of total billed charges,24% of total billed charges ,127.3,31.2,,,percent of total billed charges,31.2% of total billed charges,326.4,80,,,percent of total billed charges,80% of total billed charges,97.92,24,,,percent of total billed charges,24% of total billed charges ,97.92,24,,,percent of total billed charges,24% of total billed charges ,97.92,326.4,
ENDOPATH GRASPERS 5MM C4120,2500927,CDM,272,RC,,,Outpatient,,,469.5,234.75,,126.11,26.86,,,percent of total billed charges,26.86% of total billed charges,352.13,75,,,percent of total billed charges,75% of total billed charges ,352.13,75,,,percent of total billed charges,75% of total billed charges ,112.68,24,,,percent of total billed charges,24% of total billed charges ,352.13,75,,,percent of total billed charges,75% of total billed charges ,352.13,75,,,percent of total billed charges,75% of total billed charges ,375.6,80,,,percent of total billed charges,80% of total billed charges ,113.81,24.24,,,percent of total billed charges,24.24% of total billed charges ,236.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,352.13,75,,,percent of total billed charges,75% of total billed charges ,114.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,126.11,26.86,,,percent of total billed charges,26.86% of total billed charges,112.68,24,,,percent of total billed charges,24% of total billed charges ,146.48,31.2,,,percent of total billed charges,31.2% of total billed charges,375.6,80,,,percent of total billed charges,80% of total billed charges,112.68,24,,,percent of total billed charges,24% of total billed charges ,112.68,24,,,percent of total billed charges,24% of total billed charges ,112.68,375.6,
ENDO CURVED SCIS CB030,2500930,CDM,272,RC,,,Outpatient,,,516,258,,138.6,26.86,,,percent of total billed charges,26.86% of total billed charges,387,75,,,percent of total billed charges,75% of total billed charges ,387,75,,,percent of total billed charges,75% of total billed charges ,123.84,24,,,percent of total billed charges,24% of total billed charges ,387,75,,,percent of total billed charges,75% of total billed charges ,387,75,,,percent of total billed charges,75% of total billed charges ,412.8,80,,,percent of total billed charges,80% of total billed charges ,125.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,260.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,387,75,,,percent of total billed charges,75% of total billed charges ,126.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,138.6,26.86,,,percent of total billed charges,26.86% of total billed charges,123.84,24,,,percent of total billed charges,24% of total billed charges ,160.99,31.2,,,percent of total billed charges,31.2% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,123.84,24,,,percent of total billed charges,24% of total billed charges ,123.84,24,,,percent of total billed charges,24% of total billed charges ,123.84,412.8,
LINEAR CUTTER TLC75,2500935,CDM,272,RC,,,Outpatient,,,693,346.5,,186.14,26.86,,,percent of total billed charges,26.86% of total billed charges,519.75,75,,,percent of total billed charges,75% of total billed charges ,519.75,75,,,percent of total billed charges,75% of total billed charges ,166.32,24,,,percent of total billed charges,24% of total billed charges ,519.75,75,,,percent of total billed charges,75% of total billed charges ,519.75,75,,,percent of total billed charges,75% of total billed charges ,554.4,80,,,percent of total billed charges,80% of total billed charges ,167.98,24.24,,,percent of total billed charges,24.24% of total billed charges ,349.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,519.75,75,,,percent of total billed charges,75% of total billed charges ,169.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,186.14,26.86,,,percent of total billed charges,26.86% of total billed charges,166.32,24,,,percent of total billed charges,24% of total billed charges ,216.22,31.2,,,percent of total billed charges,31.2% of total billed charges,554.4,80,,,percent of total billed charges,80% of total billed charges,166.32,24,,,percent of total billed charges,24% of total billed charges ,166.32,24,,,percent of total billed charges,24% of total billed charges ,166.32,554.4,
PROXIMATE RELOAD CUTTER TL,2500936,CDM,272,RC,,,Outpatient,,,693,346.5,,186.14,26.86,,,percent of total billed charges,26.86% of total billed charges,519.75,75,,,percent of total billed charges,75% of total billed charges ,519.75,75,,,percent of total billed charges,75% of total billed charges ,166.32,24,,,percent of total billed charges,24% of total billed charges ,519.75,75,,,percent of total billed charges,75% of total billed charges ,519.75,75,,,percent of total billed charges,75% of total billed charges ,554.4,80,,,percent of total billed charges,80% of total billed charges ,167.98,24.24,,,percent of total billed charges,24.24% of total billed charges ,349.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,519.75,75,,,percent of total billed charges,75% of total billed charges ,169.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,186.14,26.86,,,percent of total billed charges,26.86% of total billed charges,166.32,24,,,percent of total billed charges,24% of total billed charges ,216.22,31.2,,,percent of total billed charges,31.2% of total billed charges,554.4,80,,,percent of total billed charges,80% of total billed charges,166.32,24,,,percent of total billed charges,24% of total billed charges ,166.32,24,,,percent of total billed charges,24% of total billed charges ,166.32,554.4,
BIOPSY FORCEPS 1341,2500942,CDM,272,RC,,,Outpatient,,,233,116.5,,62.58,26.86,,,percent of total billed charges,26.86% of total billed charges,174.75,75,,,percent of total billed charges,75% of total billed charges ,174.75,75,,,percent of total billed charges,75% of total billed charges ,55.92,24,,,percent of total billed charges,24% of total billed charges ,174.75,75,,,percent of total billed charges,75% of total billed charges ,174.75,75,,,percent of total billed charges,75% of total billed charges ,186.4,80,,,percent of total billed charges,80% of total billed charges ,56.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,117.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,174.75,75,,,percent of total billed charges,75% of total billed charges ,57.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,62.58,26.86,,,percent of total billed charges,26.86% of total billed charges,55.92,24,,,percent of total billed charges,24% of total billed charges ,72.7,31.2,,,percent of total billed charges,31.2% of total billed charges,186.4,80,,,percent of total billed charges,80% of total billed charges,55.92,24,,,percent of total billed charges,24% of total billed charges ,55.92,24,,,percent of total billed charges,24% of total billed charges ,55.92,186.4,
INVERTA-PEG GST KIT 20 FR,2500943,CDM,272,RC,,,Outpatient,,,1380,690,,370.67,26.86,,,percent of total billed charges,26.86% of total billed charges,1035,75,,,percent of total billed charges,75% of total billed charges ,1035,75,,,percent of total billed charges,75% of total billed charges ,331.2,24,,,percent of total billed charges,24% of total billed charges ,1035,75,,,percent of total billed charges,75% of total billed charges ,1035,75,,,percent of total billed charges,75% of total billed charges ,1104,80,,,percent of total billed charges,80% of total billed charges ,334.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,695.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,1035,75,,,percent of total billed charges,75% of total billed charges ,337.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,370.67,26.86,,,percent of total billed charges,26.86% of total billed charges,331.2,24,,,percent of total billed charges,24% of total billed charges ,430.56,31.2,,,percent of total billed charges,31.2% of total billed charges,1104,80,,,percent of total billed charges,80% of total billed charges,331.2,24,,,percent of total billed charges,24% of total billed charges ,331.2,24,,,percent of total billed charges,24% of total billed charges ,331.2,1104,
BIOPSY FORCEPS FB-240U.A,2500944,CDM,272,RC,,,Outpatient,,,233,116.5,,62.58,26.86,,,percent of total billed charges,26.86% of total billed charges,174.75,75,,,percent of total billed charges,75% of total billed charges ,174.75,75,,,percent of total billed charges,75% of total billed charges ,55.92,24,,,percent of total billed charges,24% of total billed charges ,174.75,75,,,percent of total billed charges,75% of total billed charges ,174.75,75,,,percent of total billed charges,75% of total billed charges ,186.4,80,,,percent of total billed charges,80% of total billed charges ,56.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,117.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,174.75,75,,,percent of total billed charges,75% of total billed charges ,57.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,62.58,26.86,,,percent of total billed charges,26.86% of total billed charges,55.92,24,,,percent of total billed charges,24% of total billed charges ,72.7,31.2,,,percent of total billed charges,31.2% of total billed charges,186.4,80,,,percent of total billed charges,80% of total billed charges,55.92,24,,,percent of total billed charges,24% of total billed charges ,55.92,24,,,percent of total billed charges,24% of total billed charges ,55.92,186.4,
POLYPECTOMY SNARE SD-240U-,2500945,CDM,272,RC,,,Outpatient,,,641.5,320.75,,172.31,26.86,,,percent of total billed charges,26.86% of total billed charges,481.13,75,,,percent of total billed charges,75% of total billed charges ,481.13,75,,,percent of total billed charges,75% of total billed charges ,153.96,24,,,percent of total billed charges,24% of total billed charges ,481.13,75,,,percent of total billed charges,75% of total billed charges ,481.13,75,,,percent of total billed charges,75% of total billed charges ,513.2,80,,,percent of total billed charges,80% of total billed charges ,155.5,24.24,,,percent of total billed charges,24.24% of total billed charges ,323.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,481.13,75,,,percent of total billed charges,75% of total billed charges ,157.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,172.31,26.86,,,percent of total billed charges,26.86% of total billed charges,153.96,24,,,percent of total billed charges,24% of total billed charges ,200.15,31.2,,,percent of total billed charges,31.2% of total billed charges,513.2,80,,,percent of total billed charges,80% of total billed charges,153.96,24,,,percent of total billed charges,24% of total billed charges ,153.96,24,,,percent of total billed charges,24% of total billed charges ,153.96,513.2,
DISP SCLEROTHERAPY NEEDLE,2500948,CDM,272,RC,,,Outpatient,,,206,103,,55.33,26.86,,,percent of total billed charges,26.86% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,164.8,80,,,percent of total billed charges,80% of total billed charges ,49.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,103.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,50.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,55.33,26.86,,,percent of total billed charges,26.86% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,64.27,31.2,,,percent of total billed charges,31.2% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,164.8,
SUTURE BOOT,2500950,CDM,270,RC,,,Outpatient,,,6,3,,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.8,80,,,percent of total billed charges,80% of total billed charges ,1.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.87,31.2,,,percent of total billed charges,31.2% of total billed charges,4.8,80,,,percent of total billed charges,80% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,4.8,
JACKSON-PRATT,2500966,CDM,272,RC,,,Outpatient,,,120.5,60.25,,32.37,26.86,,,percent of total billed charges,26.86% of total billed charges,90.38,75,,,percent of total billed charges,75% of total billed charges ,90.38,75,,,percent of total billed charges,75% of total billed charges ,28.92,24,,,percent of total billed charges,24% of total billed charges ,90.38,75,,,percent of total billed charges,75% of total billed charges ,90.38,75,,,percent of total billed charges,75% of total billed charges ,96.4,80,,,percent of total billed charges,80% of total billed charges ,29.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,90.38,75,,,percent of total billed charges,75% of total billed charges ,29.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.37,26.86,,,percent of total billed charges,26.86% of total billed charges,28.92,24,,,percent of total billed charges,24% of total billed charges ,37.6,31.2,,,percent of total billed charges,31.2% of total billed charges,96.4,80,,,percent of total billed charges,80% of total billed charges,28.92,24,,,percent of total billed charges,24% of total billed charges ,28.92,24,,,percent of total billed charges,24% of total billed charges ,28.92,96.4,
DISP BIOPSY FORCEPS (BRONC,2500971,CDM,272,RC,,,Outpatient,,,523,261.5,,140.48,26.86,,,percent of total billed charges,26.86% of total billed charges,392.25,75,,,percent of total billed charges,75% of total billed charges ,392.25,75,,,percent of total billed charges,75% of total billed charges ,125.52,24,,,percent of total billed charges,24% of total billed charges ,392.25,75,,,percent of total billed charges,75% of total billed charges ,392.25,75,,,percent of total billed charges,75% of total billed charges ,418.4,80,,,percent of total billed charges,80% of total billed charges ,126.78,24.24,,,percent of total billed charges,24.24% of total billed charges ,263.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,392.25,75,,,percent of total billed charges,75% of total billed charges ,128.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,140.48,26.86,,,percent of total billed charges,26.86% of total billed charges,125.52,24,,,percent of total billed charges,24% of total billed charges ,163.18,31.2,,,percent of total billed charges,31.2% of total billed charges,418.4,80,,,percent of total billed charges,80% of total billed charges,125.52,24,,,percent of total billed charges,24% of total billed charges ,125.52,24,,,percent of total billed charges,24% of total billed charges ,125.52,418.4,
CATH PLUG,2500976,CDM,270,RC,,,Outpatient,,,6,3,,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.8,80,,,percent of total billed charges,80% of total billed charges ,1.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.87,31.2,,,percent of total billed charges,31.2% of total billed charges,4.8,80,,,percent of total billed charges,80% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,4.8,
MIDSTREAM,2500980,CDM,270,RC,,,Outpatient,,,59.5,29.75,,15.98,26.86,,,percent of total billed charges,26.86% of total billed charges,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.98,26.86,,,percent of total billed charges,26.86% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,47.6,
IV START KIT,2500984,CDM,270,RC,,,Outpatient,,,36,18,,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,28.8,80,,,percent of total billed charges,80% of total billed charges ,8.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,11.23,31.2,,,percent of total billed charges,31.2% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,28.8,
UNDERPADS,2500986,CDM,270,RC,,,Outpatient,,,11.5,5.75,,3.09,26.86,,,percent of total billed charges,26.86% of total billed charges,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,9.2,80,,,percent of total billed charges,80% of total billed charges ,2.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.09,26.86,,,percent of total billed charges,26.86% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,3.59,31.2,,,percent of total billed charges,31.2% of total billed charges,9.2,80,,,percent of total billed charges,80% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,9.2,
EGG CRATE,2500988,CDM,270,RC,,,Outpatient,,,212,106,,56.94,26.86,,,percent of total billed charges,26.86% of total billed charges,159,75,,,percent of total billed charges,75% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,50.88,24,,,percent of total billed charges,24% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,169.6,80,,,percent of total billed charges,80% of total billed charges ,51.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,106.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,51.9,24.48,,,percent of total billed charges,24.48% of total billed charges ,56.94,26.86,,,percent of total billed charges,26.86% of total billed charges,50.88,24,,,percent of total billed charges,24% of total billed charges ,66.14,31.2,,,percent of total billed charges,31.2% of total billed charges,169.6,80,,,percent of total billed charges,80% of total billed charges,50.88,24,,,percent of total billed charges,24% of total billed charges ,50.88,24,,,percent of total billed charges,24% of total billed charges ,50.88,169.6,
ER LACERATION TRAY,2500990,CDM,272,RC,,,Outpatient,,,141,70.5,,37.87,26.86,,,percent of total billed charges,26.86% of total billed charges,105.75,75,,,percent of total billed charges,75% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,112.8,80,,,percent of total billed charges,80% of total billed charges ,34.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,71.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,34.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.87,26.86,,,percent of total billed charges,26.86% of total billed charges,33.84,24,,,percent of total billed charges,24% of total billed charges ,43.99,31.2,,,percent of total billed charges,31.2% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,33.84,24,,,percent of total billed charges,24% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,33.84,112.8,
TEGERDERM IV,2500992,CDM,270,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
CATH TRAY ADD-A FOLEY,2500996,CDM,272,RC,,,Outpatient,,,306,153,,82.19,26.86,,,percent of total billed charges,26.86% of total billed charges,229.5,75,,,percent of total billed charges,75% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,73.44,24,,,percent of total billed charges,24% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,244.8,80,,,percent of total billed charges,80% of total billed charges ,74.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,154.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,74.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,82.19,26.86,,,percent of total billed charges,26.86% of total billed charges,73.44,24,,,percent of total billed charges,24% of total billed charges ,95.47,31.2,,,percent of total billed charges,31.2% of total billed charges,244.8,80,,,percent of total billed charges,80% of total billed charges,73.44,24,,,percent of total billed charges,24% of total billed charges ,73.44,24,,,percent of total billed charges,24% of total billed charges ,73.44,244.8,
URETHRAL CATH TRAY,2500999,CDM,270,RC,,,Outpatient,,,116.5,58.25,,31.29,26.86,,,percent of total billed charges,26.86% of total billed charges,87.38,75,,,percent of total billed charges,75% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,27.96,24,,,percent of total billed charges,24% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,93.2,80,,,percent of total billed charges,80% of total billed charges ,28.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,58.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,28.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.29,26.86,,,percent of total billed charges,26.86% of total billed charges,27.96,24,,,percent of total billed charges,24% of total billed charges ,36.35,31.2,,,percent of total billed charges,31.2% of total billed charges,93.2,80,,,percent of total billed charges,80% of total billed charges,27.96,24,,,percent of total billed charges,24% of total billed charges ,27.96,24,,,percent of total billed charges,24% of total billed charges ,27.96,93.2,
HEEL PROTECTOR,2501000,CDM,270,RC,,,Outpatient,,,143,71.5,,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,114.4,80,,,percent of total billed charges,80% of total billed charges ,34.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,35.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,44.62,31.2,,,percent of total billed charges,31.2% of total billed charges,114.4,80,,,percent of total billed charges,80% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,114.4,
ADAPTIC 3X3,2501001,CDM,270,RC,,,Outpatient,,,8,4,,2.15,26.86,,,percent of total billed charges,26.86% of total billed charges,6,75,,,percent of total billed charges,75% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,6.4,80,,,percent of total billed charges,80% of total billed charges ,1.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.15,26.86,,,percent of total billed charges,26.86% of total billed charges,1.92,24,,,percent of total billed charges,24% of total billed charges ,2.5,31.2,,,percent of total billed charges,31.2% of total billed charges,6.4,80,,,percent of total billed charges,80% of total billed charges,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,6.4,
ADAPTIC 3X8,2501002,CDM,270,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
BITE STICK,2501005,CDM,270,RC,,,Outpatient,,,29,14.5,,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,23.2,80,,,percent of total billed charges,80% of total billed charges ,7.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,7.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,9.05,31.2,,,percent of total billed charges,31.2% of total billed charges,23.2,80,,,percent of total billed charges,80% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,23.2,
CATH FOLEY 2WAY 26 FR,2501014,CDM,272,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
AIRCAST LEFT,2501021,CDM,270,RC,,,Outpatient,,,451,225.5,,121.14,26.86,,,percent of total billed charges,26.86% of total billed charges,338.25,75,,,percent of total billed charges,75% of total billed charges ,338.25,75,,,percent of total billed charges,75% of total billed charges ,108.24,24,,,percent of total billed charges,24% of total billed charges ,338.25,75,,,percent of total billed charges,75% of total billed charges ,338.25,75,,,percent of total billed charges,75% of total billed charges ,360.8,80,,,percent of total billed charges,80% of total billed charges ,109.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,227.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,338.25,75,,,percent of total billed charges,75% of total billed charges ,110.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,121.14,26.86,,,percent of total billed charges,26.86% of total billed charges,108.24,24,,,percent of total billed charges,24% of total billed charges ,140.71,31.2,,,percent of total billed charges,31.2% of total billed charges,360.8,80,,,percent of total billed charges,80% of total billed charges,108.24,24,,,percent of total billed charges,24% of total billed charges ,108.24,24,,,percent of total billed charges,24% of total billed charges ,108.24,360.8,
AIRCAST RIGHT,2501022,CDM,270,RC,,,Outpatient,,,451,225.5,,121.14,26.86,,,percent of total billed charges,26.86% of total billed charges,338.25,75,,,percent of total billed charges,75% of total billed charges ,338.25,75,,,percent of total billed charges,75% of total billed charges ,108.24,24,,,percent of total billed charges,24% of total billed charges ,338.25,75,,,percent of total billed charges,75% of total billed charges ,338.25,75,,,percent of total billed charges,75% of total billed charges ,360.8,80,,,percent of total billed charges,80% of total billed charges ,109.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,227.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,338.25,75,,,percent of total billed charges,75% of total billed charges ,110.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,121.14,26.86,,,percent of total billed charges,26.86% of total billed charges,108.24,24,,,percent of total billed charges,24% of total billed charges ,140.71,31.2,,,percent of total billed charges,31.2% of total billed charges,360.8,80,,,percent of total billed charges,80% of total billed charges,108.24,24,,,percent of total billed charges,24% of total billed charges ,108.24,24,,,percent of total billed charges,24% of total billed charges ,108.24,360.8,
DRAPE LOWER EXTREMITY,2501030,CDM,272,RC,,,Outpatient,,,48.5,24.25,,13.03,26.86,,,percent of total billed charges,26.86% of total billed charges,36.38,75,,,percent of total billed charges,75% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,38.8,80,,,percent of total billed charges,80% of total billed charges ,11.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.03,26.86,,,percent of total billed charges,26.86% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,15.13,31.2,,,percent of total billed charges,31.2% of total billed charges,38.8,80,,,percent of total billed charges,80% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,38.8,
LAP SPONGES,2501035,CDM,272,RC,,,Outpatient,,,122.5,61.25,,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,98,80,,,percent of total billed charges,80% of total billed charges ,29.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,38.22,31.2,,,percent of total billed charges,31.2% of total billed charges,98,80,,,percent of total billed charges,80% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,98,
WRIST SPLINT COCKUP L,2501036,CDM,270,RC,,,Outpatient,,,98,49,,26.32,26.86,,,percent of total billed charges,26.86% of total billed charges,73.5,75,,,percent of total billed charges,75% of total billed charges ,73.5,75,,,percent of total billed charges,75% of total billed charges ,23.52,24,,,percent of total billed charges,24% of total billed charges ,73.5,75,,,percent of total billed charges,75% of total billed charges ,73.5,75,,,percent of total billed charges,75% of total billed charges ,78.4,80,,,percent of total billed charges,80% of total billed charges ,23.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,49.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,73.5,75,,,percent of total billed charges,75% of total billed charges ,23.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.32,26.86,,,percent of total billed charges,26.86% of total billed charges,23.52,24,,,percent of total billed charges,24% of total billed charges ,30.58,31.2,,,percent of total billed charges,31.2% of total billed charges,78.4,80,,,percent of total billed charges,80% of total billed charges,23.52,24,,,percent of total billed charges,24% of total billed charges ,23.52,24,,,percent of total billed charges,24% of total billed charges ,23.52,78.4,
WRIST SPLINT  R,2501037,CDM,270,RC,,,Outpatient,,,98,49,,26.32,26.86,,,percent of total billed charges,26.86% of total billed charges,73.5,75,,,percent of total billed charges,75% of total billed charges ,73.5,75,,,percent of total billed charges,75% of total billed charges ,23.52,24,,,percent of total billed charges,24% of total billed charges ,73.5,75,,,percent of total billed charges,75% of total billed charges ,73.5,75,,,percent of total billed charges,75% of total billed charges ,78.4,80,,,percent of total billed charges,80% of total billed charges ,23.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,49.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,73.5,75,,,percent of total billed charges,75% of total billed charges ,23.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.32,26.86,,,percent of total billed charges,26.86% of total billed charges,23.52,24,,,percent of total billed charges,24% of total billed charges ,30.58,31.2,,,percent of total billed charges,31.2% of total billed charges,78.4,80,,,percent of total billed charges,80% of total billed charges,23.52,24,,,percent of total billed charges,24% of total billed charges ,23.52,24,,,percent of total billed charges,24% of total billed charges ,23.52,78.4,
ARM SLING CHILD,2501038,CDM,270,RC,,,Outpatient,,,69,34.5,,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,55.2,80,,,percent of total billed charges,80% of total billed charges ,16.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,21.53,31.2,,,percent of total billed charges,31.2% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,55.2,
UNIVERSAL ARM SLING,2501039,CDM,270,RC,,,Outpatient,,,69,34.5,,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,55.2,80,,,percent of total billed charges,80% of total billed charges ,16.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,21.53,31.2,,,percent of total billed charges,31.2% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,55.2,
ARM SLING L,2501040,CDM,270,RC,,,Outpatient,,,69,34.5,,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,55.2,80,,,percent of total billed charges,80% of total billed charges ,16.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,21.53,31.2,,,percent of total billed charges,31.2% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,55.2,
KUMPE 5FR  40CM,2501045,CDM,272,RC,,,Outpatient,,,132,66,,35.46,26.86,,,percent of total billed charges,26.86% of total billed charges,99,75,,,percent of total billed charges,75% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,31.68,24,,,percent of total billed charges,24% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,105.6,80,,,percent of total billed charges,80% of total billed charges ,32,24.24,,,percent of total billed charges,24.24% of total billed charges ,66.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,32.31,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.46,26.86,,,percent of total billed charges,26.86% of total billed charges,31.68,24,,,percent of total billed charges,24% of total billed charges ,41.18,31.2,,,percent of total billed charges,31.2% of total billed charges,105.6,80,,,percent of total billed charges,80% of total billed charges,31.68,24,,,percent of total billed charges,24% of total billed charges ,31.68,24,,,percent of total billed charges,24% of total billed charges ,31.68,105.6,
KUMPE 5FR 65CM,2501046,CDM,272,RC,,,Outpatient,,,132,66,,35.46,26.86,,,percent of total billed charges,26.86% of total billed charges,99,75,,,percent of total billed charges,75% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,31.68,24,,,percent of total billed charges,24% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,105.6,80,,,percent of total billed charges,80% of total billed charges ,32,24.24,,,percent of total billed charges,24.24% of total billed charges ,66.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,32.31,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.46,26.86,,,percent of total billed charges,26.86% of total billed charges,31.68,24,,,percent of total billed charges,24% of total billed charges ,41.18,31.2,,,percent of total billed charges,31.2% of total billed charges,105.6,80,,,percent of total billed charges,80% of total billed charges,31.68,24,,,percent of total billed charges,24% of total billed charges ,31.68,24,,,percent of total billed charges,24% of total billed charges ,31.68,105.6,
DURAPREP,2501059,CDM,272,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
ORTHO-GLASS SPL 3,2501063,CDM,270,RC,,,Outpatient,,,48.5,24.25,,13.03,26.86,,,percent of total billed charges,26.86% of total billed charges,36.38,75,,,percent of total billed charges,75% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,38.8,80,,,percent of total billed charges,80% of total billed charges ,11.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.03,26.86,,,percent of total billed charges,26.86% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,15.13,31.2,,,percent of total billed charges,31.2% of total billed charges,38.8,80,,,percent of total billed charges,80% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,38.8,
ORTHO-GLASS SPL 4,2501064,CDM,278,RC,,,Outpatient,,,48.5,24.25,,13.03,26.86,,,percent of total billed charges,26.86% of total billed charges,48.5,75,,,percent of total billed charges,75% of total billed charges ,48.5,75,,,percent of total billed charges,75% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,48.5,75,,,percent of total billed charges,75% of total billed charges ,48.5,75,,,percent of total billed charges,75% of total billed charges ,38.8,80,,,percent of total billed charges,80% of total billed charges ,11.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.03,26.86,,,percent of total billed charges,26.86% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,15.13,31.2,,,percent of total billed charges,31.2% of total billed charges,38.8,80,,,percent of total billed charges,80% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,48.5,
ORTHO-GLASS SPL.5,2501065,CDM,270,RC,,,Outpatient,,,110,55,,29.55,26.86,,,percent of total billed charges,26.86% of total billed charges,82.5,75,,,percent of total billed charges,75% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.55,26.86,,,percent of total billed charges,26.86% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,88,
PEDIATRIC WRIST SPLINT R,2501066,CDM,270,RC,,,Outpatient,,,43.5,21.75,,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,34.8,80,,,percent of total billed charges,80% of total billed charges ,10.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,10.44,24,,,percent of total billed charges,24% of total billed charges ,13.57,31.2,,,percent of total billed charges,31.2% of total billed charges,34.8,80,,,percent of total billed charges,80% of total billed charges,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,34.8,
PEDIATRIC WRIST SPLINT L,2501067,CDM,270,RC,,,Outpatient,,,43.5,21.75,,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,34.8,80,,,percent of total billed charges,80% of total billed charges ,10.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,10.44,24,,,percent of total billed charges,24% of total billed charges ,13.57,31.2,,,percent of total billed charges,31.2% of total billed charges,34.8,80,,,percent of total billed charges,80% of total billed charges,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,34.8,
SYRINGE EAR 2OZ,2501068,CDM,270,RC,,,Outpatient,,,11.5,5.75,,3.09,26.86,,,percent of total billed charges,26.86% of total billed charges,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,9.2,80,,,percent of total billed charges,80% of total billed charges ,2.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.09,26.86,,,percent of total billed charges,26.86% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,3.59,31.2,,,percent of total billed charges,31.2% of total billed charges,9.2,80,,,percent of total billed charges,80% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,9.2,
DRAPE UNDER BUTTOCK,2501069,CDM,272,RC,,,Outpatient,,,116.5,58.25,,31.29,26.86,,,percent of total billed charges,26.86% of total billed charges,87.38,75,,,percent of total billed charges,75% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,27.96,24,,,percent of total billed charges,24% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,93.2,80,,,percent of total billed charges,80% of total billed charges ,28.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,58.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,28.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.29,26.86,,,percent of total billed charges,26.86% of total billed charges,27.96,24,,,percent of total billed charges,24% of total billed charges ,36.35,31.2,,,percent of total billed charges,31.2% of total billed charges,93.2,80,,,percent of total billed charges,80% of total billed charges,27.96,24,,,percent of total billed charges,24% of total billed charges ,27.96,24,,,percent of total billed charges,24% of total billed charges ,27.96,93.2,
QUIK -COMBO ELECTRODE ADUL,2501098,CDM,270,RC,,,Outpatient,,,189.5,94.75,,50.9,26.86,,,percent of total billed charges,26.86% of total billed charges,142.13,75,,,percent of total billed charges,75% of total billed charges ,142.13,75,,,percent of total billed charges,75% of total billed charges ,45.48,24,,,percent of total billed charges,24% of total billed charges ,142.13,75,,,percent of total billed charges,75% of total billed charges ,142.13,75,,,percent of total billed charges,75% of total billed charges ,151.6,80,,,percent of total billed charges,80% of total billed charges ,45.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,95.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,142.13,75,,,percent of total billed charges,75% of total billed charges ,46.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,50.9,26.86,,,percent of total billed charges,26.86% of total billed charges,45.48,24,,,percent of total billed charges,24% of total billed charges ,59.12,31.2,,,percent of total billed charges,31.2% of total billed charges,151.6,80,,,percent of total billed charges,80% of total billed charges,45.48,24,,,percent of total billed charges,24% of total billed charges ,45.48,24,,,percent of total billed charges,24% of total billed charges ,45.48,151.6,
PED.MULTI-LUMEN CENTRAL CA,2501103,CDM,278,RC,C1751,HCPCS,Outpatient,,,246,123,,66.08,26.86,,,percent of total billed charges,26.86% of total billed charges,246,75,,,percent of total billed charges,75% of total billed charges ,246,75,,,percent of total billed charges,75% of total billed charges ,59.04,24,,,percent of total billed charges,24% of total billed charges ,246,75,,,percent of total billed charges,75% of total billed charges ,246,75,,,percent of total billed charges,75% of total billed charges ,196.8,80,,,percent of total billed charges,80% of total billed charges ,59.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,123.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,184.5,75,,,percent of total billed charges,75% of total billed charges ,60.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,66.08,26.86,,,percent of total billed charges,26.86% of total billed charges,59.04,24,,,percent of total billed charges,24% of total billed charges ,76.75,31.2,,,percent of total billed charges,31.2% of total billed charges,196.8,80,,,percent of total billed charges,80% of total billed charges,59.04,24,,,percent of total billed charges,24% of total billed charges ,59.04,24,,,percent of total billed charges,24% of total billed charges ,59.04,246,
CORE BIOPSY INSTRUMENT MONOPTY,2501112,CDM,270,RC,,,Outpatient,,,281,140.5,,75.48,26.86,,,percent of total billed charges,26.86% of total billed charges,210.75,75,,,percent of total billed charges,75% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,67.44,24,,,percent of total billed charges,24% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,224.8,80,,,percent of total billed charges,80% of total billed charges ,68.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,141.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,68.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,75.48,26.86,,,percent of total billed charges,26.86% of total billed charges,67.44,24,,,percent of total billed charges,24% of total billed charges ,87.67,31.2,,,percent of total billed charges,31.2% of total billed charges,224.8,80,,,percent of total billed charges,80% of total billed charges,67.44,24,,,percent of total billed charges,24% of total billed charges ,67.44,24,,,percent of total billed charges,24% of total billed charges ,67.44,224.8,
ULTRACLIP TISSUE MARKER BREAST,2501113,CDM,270,RC,,,Outpatient,,,286.5,143.25,,76.95,26.86,,,percent of total billed charges,26.86% of total billed charges,214.88,75,,,percent of total billed charges,75% of total billed charges ,214.88,75,,,percent of total billed charges,75% of total billed charges ,68.76,24,,,percent of total billed charges,24% of total billed charges ,214.88,75,,,percent of total billed charges,75% of total billed charges ,214.88,75,,,percent of total billed charges,75% of total billed charges ,229.2,80,,,percent of total billed charges,80% of total billed charges ,69.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,144.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,214.88,75,,,percent of total billed charges,75% of total billed charges ,70.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,76.95,26.86,,,percent of total billed charges,26.86% of total billed charges,68.76,24,,,percent of total billed charges,24% of total billed charges ,89.39,31.2,,,percent of total billed charges,31.2% of total billed charges,229.2,80,,,percent of total billed charges,80% of total billed charges,68.76,24,,,percent of total billed charges,24% of total billed charges ,68.76,24,,,percent of total billed charges,24% of total billed charges ,68.76,229.2,
CATH. PED. 6FR.,2501114,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
UNNA BOOT (WHITE BOX),2501117,CDM,270,RC,,,Outpatient,,,104,52,,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,83.2,80,,,percent of total billed charges,80% of total billed charges ,25.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,25.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,32.45,31.2,,,percent of total billed charges,31.2% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,83.2,
LAPARSCOPIC CHOLANGIOGRAM,2501122,CDM,270,RC,,,Outpatient,,,679,339.5,,182.38,26.86,,,percent of total billed charges,26.86% of total billed charges,509.25,75,,,percent of total billed charges,75% of total billed charges ,509.25,75,,,percent of total billed charges,75% of total billed charges ,162.96,24,,,percent of total billed charges,24% of total billed charges ,509.25,75,,,percent of total billed charges,75% of total billed charges ,509.25,75,,,percent of total billed charges,75% of total billed charges ,543.2,80,,,percent of total billed charges,80% of total billed charges ,164.59,24.24,,,percent of total billed charges,24.24% of total billed charges ,342.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,509.25,75,,,percent of total billed charges,75% of total billed charges ,166.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,182.38,26.86,,,percent of total billed charges,26.86% of total billed charges,162.96,24,,,percent of total billed charges,24% of total billed charges ,211.85,31.2,,,percent of total billed charges,31.2% of total billed charges,543.2,80,,,percent of total billed charges,80% of total billed charges,162.96,24,,,percent of total billed charges,24% of total billed charges ,162.96,24,,,percent of total billed charges,24% of total billed charges ,162.96,543.2,
MALE CATH TEXAS SMALL,2501124,CDM,270,RC,,,Outpatient,,,41,20.5,,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,32.8,80,,,percent of total billed charges,80% of total billed charges ,9.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,10.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,12.79,31.2,,,percent of total billed charges,31.2% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,32.8,
PELVIC TRACTION BELT UNIVE,2501127,CDM,270,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
LIGA-CLIP MCL20,2501129,CDM,272,RC,,,Outpatient,,,408,204,,109.59,26.86,,,percent of total billed charges,26.86% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges ,306,75,,,percent of total billed charges,75% of total billed charges ,97.92,24,,,percent of total billed charges,24% of total billed charges ,306,75,,,percent of total billed charges,75% of total billed charges ,306,75,,,percent of total billed charges,75% of total billed charges ,326.4,80,,,percent of total billed charges,80% of total billed charges ,98.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,205.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,306,75,,,percent of total billed charges,75% of total billed charges ,99.88,24.48,,,percent of total billed charges,24.48% of total billed charges ,109.59,26.86,,,percent of total billed charges,26.86% of total billed charges,97.92,24,,,percent of total billed charges,24% of total billed charges ,127.3,31.2,,,percent of total billed charges,31.2% of total billed charges,326.4,80,,,percent of total billed charges,80% of total billed charges,97.92,24,,,percent of total billed charges,24% of total billed charges ,97.92,24,,,percent of total billed charges,24% of total billed charges ,97.92,326.4,
ENDO POUCH 10MM CD001,2501137,CDM,272,RC,,,Outpatient,,,124.5,62.25,,33.44,26.86,,,percent of total billed charges,26.86% of total billed charges,93.38,75,,,percent of total billed charges,75% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,29.88,24,,,percent of total billed charges,24% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,99.6,80,,,percent of total billed charges,80% of total billed charges ,30.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,62.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,30.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,33.44,26.86,,,percent of total billed charges,26.86% of total billed charges,29.88,24,,,percent of total billed charges,24% of total billed charges ,38.84,31.2,,,percent of total billed charges,31.2% of total billed charges,99.6,80,,,percent of total billed charges,80% of total billed charges,29.88,24,,,percent of total billed charges,24% of total billed charges ,29.88,24,,,percent of total billed charges,24% of total billed charges ,29.88,99.6,
EXUDERM 4X4,2501139,CDM,270,RC,,,Outpatient,,,28,14,,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,22.4,80,,,percent of total billed charges,80% of total billed charges ,6.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,8.74,31.2,,,percent of total billed charges,31.2% of total billed charges,22.4,80,,,percent of total billed charges,80% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,22.4,
ABDUCTION PILLOW,2501141,CDM,270,RC,,,Outpatient,,,196.5,98.25,,52.78,26.86,,,percent of total billed charges,26.86% of total billed charges,147.38,75,,,percent of total billed charges,75% of total billed charges ,147.38,75,,,percent of total billed charges,75% of total billed charges ,47.16,24,,,percent of total billed charges,24% of total billed charges ,147.38,75,,,percent of total billed charges,75% of total billed charges ,147.38,75,,,percent of total billed charges,75% of total billed charges ,157.2,80,,,percent of total billed charges,80% of total billed charges ,47.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,99.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,147.38,75,,,percent of total billed charges,75% of total billed charges ,48.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,52.78,26.86,,,percent of total billed charges,26.86% of total billed charges,47.16,24,,,percent of total billed charges,24% of total billed charges ,61.31,31.2,,,percent of total billed charges,31.2% of total billed charges,157.2,80,,,percent of total billed charges,80% of total billed charges,47.16,24,,,percent of total billed charges,24% of total billed charges ,47.16,24,,,percent of total billed charges,24% of total billed charges ,47.16,157.2,
PROCEDURE/PROLAPSE HEMORRH,2501159,CDM,360,RC,46947,HCPCS,Outpatient,,,2930.5,1465.25,,787.13,26.86,,,percent of total billed charges,26.86% of total billed charges,2197.88,75,,,percent of total billed charges,75% of total billed charges ,2197.88,75,,,percent of total billed charges,75% of total billed charges ,703.32,24,,,percent of total billed charges,24% of total billed charges ,2197.88,75,,,percent of total billed charges,75% of total billed charges ,2197.88,75,,,percent of total billed charges,75% of total billed charges ,2344.4,80,,,percent of total billed charges,80% of total billed charges ,710.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,1476.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,2197.88,75,,,percent of total billed charges,75% of total billed charges ,717.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,787.13,26.86,,,percent of total billed charges,26.86% of total billed charges,703.32,24,,,percent of total billed charges,24% of total billed charges ,914.32,31.2,,,percent of total billed charges,31.2% of total billed charges,2344.4,80,,,percent of total billed charges,80% of total billed charges,703.32,24,,,percent of total billed charges,24% of total billed charges ,703.32,24,,,percent of total billed charges,24% of total billed charges ,703.32,2344.4,
CONQUEST CQ7574,2501163,CDM,278,RC,C1725,HCPCS,Outpatient,,,2384.5,1192.25,,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1907.6,80,,,percent of total billed charges,80% of total billed charges ,578,24.24,,,percent of total billed charges,24.24% of total billed charges ,1201.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,583.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,743.96,31.2,,,percent of total billed charges,31.2% of total billed charges,1907.6,80,,,percent of total billed charges,80% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,1907.6,
MEFIX 4,2501164,CDM,270,RC,,,Outpatient,,,126.5,63.25,,33.98,26.86,,,percent of total billed charges,26.86% of total billed charges,94.88,75,,,percent of total billed charges,75% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,30.36,24,,,percent of total billed charges,24% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,101.2,80,,,percent of total billed charges,80% of total billed charges ,30.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,63.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,30.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,33.98,26.86,,,percent of total billed charges,26.86% of total billed charges,30.36,24,,,percent of total billed charges,24% of total billed charges ,39.47,31.2,,,percent of total billed charges,31.2% of total billed charges,101.2,80,,,percent of total billed charges,80% of total billed charges,30.36,24,,,percent of total billed charges,24% of total billed charges ,30.36,24,,,percent of total billed charges,24% of total billed charges ,30.36,101.2,
THORACIC CATH 24FR.,2501167,CDM,272,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
INFANT LUMBAR PUNTURE TRAY,2501173,CDM,272,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
CONQUEST BALLOON CQ75124,2501174,CDM,278,RC,C1725,HCPCS,Outpatient,,,2384.5,1192.25,,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1907.6,80,,,percent of total billed charges,80% of total billed charges ,578,24.24,,,percent of total billed charges,24.24% of total billed charges ,1201.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,583.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,743.96,31.2,,,percent of total billed charges,31.2% of total billed charges,1907.6,80,,,percent of total billed charges,80% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,1907.6,
CONQUEST CQ5074,2501177,CDM,278,RC,C1725,HCPCS,Outpatient,,,2384.5,1192.25,,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1907.6,80,,,percent of total billed charges,80% of total billed charges ,578,24.24,,,percent of total billed charges,24.24% of total billed charges ,1201.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,583.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,743.96,31.2,,,percent of total billed charges,31.2% of total billed charges,1907.6,80,,,percent of total billed charges,80% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,1907.6,
QUIK-COMBO PEDIATRIC,2501178,CDM,270,RC,,,Outpatient,,,206,103,,55.33,26.86,,,percent of total billed charges,26.86% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,164.8,80,,,percent of total billed charges,80% of total billed charges ,49.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,103.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,50.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,55.33,26.86,,,percent of total billed charges,26.86% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,64.27,31.2,,,percent of total billed charges,31.2% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,164.8,
CATH 24FR.3W 30CC,2501183,CDM,272,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
LINEAR CUTTER TR45W,2501187,CDM,272,RC,,,Outpatient,,,755,377.5,,202.79,26.86,,,percent of total billed charges,26.86% of total billed charges,566.25,75,,,percent of total billed charges,75% of total billed charges ,566.25,75,,,percent of total billed charges,75% of total billed charges ,181.2,24,,,percent of total billed charges,24% of total billed charges ,566.25,75,,,percent of total billed charges,75% of total billed charges ,566.25,75,,,percent of total billed charges,75% of total billed charges ,604,80,,,percent of total billed charges,80% of total billed charges ,183.01,24.24,,,percent of total billed charges,24.24% of total billed charges ,380.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,566.25,75,,,percent of total billed charges,75% of total billed charges ,184.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,202.79,26.86,,,percent of total billed charges,26.86% of total billed charges,181.2,24,,,percent of total billed charges,24% of total billed charges ,235.56,31.2,,,percent of total billed charges,31.2% of total billed charges,604,80,,,percent of total billed charges,80% of total billed charges,181.2,24,,,percent of total billed charges,24% of total billed charges ,181.2,24,,,percent of total billed charges,24% of total billed charges ,181.2,604,
ENDOPATH RELOADS TR45W,2501188,CDM,272,RC,,,Outpatient,,,755,377.5,,202.79,26.86,,,percent of total billed charges,26.86% of total billed charges,566.25,75,,,percent of total billed charges,75% of total billed charges ,566.25,75,,,percent of total billed charges,75% of total billed charges ,181.2,24,,,percent of total billed charges,24% of total billed charges ,566.25,75,,,percent of total billed charges,75% of total billed charges ,566.25,75,,,percent of total billed charges,75% of total billed charges ,604,80,,,percent of total billed charges,80% of total billed charges ,183.01,24.24,,,percent of total billed charges,24.24% of total billed charges ,380.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,566.25,75,,,percent of total billed charges,75% of total billed charges ,184.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,202.79,26.86,,,percent of total billed charges,26.86% of total billed charges,181.2,24,,,percent of total billed charges,24% of total billed charges ,235.56,31.2,,,percent of total billed charges,31.2% of total billed charges,604,80,,,percent of total billed charges,80% of total billed charges,181.2,24,,,percent of total billed charges,24% of total billed charges ,181.2,24,,,percent of total billed charges,24% of total billed charges ,181.2,604,
MEFIX 6,2501189,CDM,270,RC,,,Outpatient,,,56.5,28.25,,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
NUGAUZE PACKING 1/4,2501199,CDM,270,RC,,,Outpatient,,,56.5,28.25,,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
NUGAUZE PACK IODOFORM 1/4,2501200,CDM,270,RC,,,Outpatient,,,56.5,28.25,,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
CAUTERY HI TEMP,2501212,CDM,272,RC,,,Outpatient,,,59.5,29.75,,15.98,26.86,,,percent of total billed charges,26.86% of total billed charges,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.98,26.86,,,percent of total billed charges,26.86% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,47.6,
CATH 8FR PED,2501222,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
CATH 10FR PED,2501223,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
CERVICAL RIGID COLLAR TALL,2501225,CDM,270,RC,,,Outpatient,,,193.5,96.75,,51.97,26.86,,,percent of total billed charges,26.86% of total billed charges,145.13,75,,,percent of total billed charges,75% of total billed charges ,145.13,75,,,percent of total billed charges,75% of total billed charges ,46.44,24,,,percent of total billed charges,24% of total billed charges ,145.13,75,,,percent of total billed charges,75% of total billed charges ,145.13,75,,,percent of total billed charges,75% of total billed charges ,154.8,80,,,percent of total billed charges,80% of total billed charges ,46.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,97.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,145.13,75,,,percent of total billed charges,75% of total billed charges ,47.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,51.97,26.86,,,percent of total billed charges,26.86% of total billed charges,46.44,24,,,percent of total billed charges,24% of total billed charges ,60.37,31.2,,,percent of total billed charges,31.2% of total billed charges,154.8,80,,,percent of total billed charges,80% of total billed charges,46.44,24,,,percent of total billed charges,24% of total billed charges ,46.44,24,,,percent of total billed charges,24% of total billed charges ,46.44,154.8,
CERVICAL RIGID REGULAR,2501226,CDM,270,RC,,,Outpatient,,,436.5,218.25,,117.24,26.86,,,percent of total billed charges,26.86% of total billed charges,327.38,75,,,percent of total billed charges,75% of total billed charges ,327.38,75,,,percent of total billed charges,75% of total billed charges ,104.76,24,,,percent of total billed charges,24% of total billed charges ,327.38,75,,,percent of total billed charges,75% of total billed charges ,327.38,75,,,percent of total billed charges,75% of total billed charges ,349.2,80,,,percent of total billed charges,80% of total billed charges ,105.81,24.24,,,percent of total billed charges,24.24% of total billed charges ,220,50.4,,,percent of total billed charges,50.4% of total billed charges ,327.38,75,,,percent of total billed charges,75% of total billed charges ,106.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,117.24,26.86,,,percent of total billed charges,26.86% of total billed charges,104.76,24,,,percent of total billed charges,24% of total billed charges ,136.19,31.2,,,percent of total billed charges,31.2% of total billed charges,349.2,80,,,percent of total billed charges,80% of total billed charges,104.76,24,,,percent of total billed charges,24% of total billed charges ,104.76,24,,,percent of total billed charges,24% of total billed charges ,104.76,349.2,
CERVICAL RIGID COLLAR PED.,2501227,CDM,270,RC,,,Outpatient,,,193.5,96.75,,51.97,26.86,,,percent of total billed charges,26.86% of total billed charges,145.13,75,,,percent of total billed charges,75% of total billed charges ,145.13,75,,,percent of total billed charges,75% of total billed charges ,46.44,24,,,percent of total billed charges,24% of total billed charges ,145.13,75,,,percent of total billed charges,75% of total billed charges ,145.13,75,,,percent of total billed charges,75% of total billed charges ,154.8,80,,,percent of total billed charges,80% of total billed charges ,46.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,97.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,145.13,75,,,percent of total billed charges,75% of total billed charges ,47.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,51.97,26.86,,,percent of total billed charges,26.86% of total billed charges,46.44,24,,,percent of total billed charges,24% of total billed charges ,60.37,31.2,,,percent of total billed charges,31.2% of total billed charges,154.8,80,,,percent of total billed charges,80% of total billed charges,46.44,24,,,percent of total billed charges,24% of total billed charges ,46.44,24,,,percent of total billed charges,24% of total billed charges ,46.44,154.8,
FEMALE CATH KIT,2501231,CDM,272,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
NASAL TAMPON,2501245,CDM,270,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
PEDIATRIC URINE BAG,2501247,CDM,270,RC,,,Outpatient,,,11.5,5.75,,3.09,26.86,,,percent of total billed charges,26.86% of total billed charges,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,9.2,80,,,percent of total billed charges,80% of total billed charges ,2.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.09,26.86,,,percent of total billed charges,26.86% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,3.59,31.2,,,percent of total billed charges,31.2% of total billed charges,9.2,80,,,percent of total billed charges,80% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,9.2,
TWIN-CATH MULTIPLE -LUMEN,2501249,CDM,272,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
RHINO ROCKET,2501253,CDM,270,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
RIB BELT MALE,2501254,CDM,270,RC,,,Outpatient,,,104,52,,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,83.2,80,,,percent of total billed charges,80% of total billed charges ,25.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,25.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,32.45,31.2,,,percent of total billed charges,31.2% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,83.2,
RIB BELT FEMALE,2501255,CDM,270,RC,,,Outpatient,,,104,52,,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,83.2,80,,,percent of total billed charges,80% of total billed charges ,25.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,25.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,32.45,31.2,,,percent of total billed charges,31.2% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,83.2,
STERI-STRIPS W8514 (OR),2501260,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
MASTISOL,2501263,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
DYNA-HEX4   4OZ.,2501267,CDM,270,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
NEPHROLOGY PACK,2501268,CDM,272,RC,,,Outpatient,,,948.5,474.25,,254.77,26.86,,,percent of total billed charges,26.86% of total billed charges,711.38,75,,,percent of total billed charges,75% of total billed charges ,711.38,75,,,percent of total billed charges,75% of total billed charges ,227.64,24,,,percent of total billed charges,24% of total billed charges ,711.38,75,,,percent of total billed charges,75% of total billed charges ,711.38,75,,,percent of total billed charges,75% of total billed charges ,758.8,80,,,percent of total billed charges,80% of total billed charges ,229.92,24.24,,,percent of total billed charges,24.24% of total billed charges ,478.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,711.38,75,,,percent of total billed charges,75% of total billed charges ,232.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,254.77,26.86,,,percent of total billed charges,26.86% of total billed charges,227.64,24,,,percent of total billed charges,24% of total billed charges ,295.93,31.2,,,percent of total billed charges,31.2% of total billed charges,758.8,80,,,percent of total billed charges,80% of total billed charges,227.64,24,,,percent of total billed charges,24% of total billed charges ,227.64,24,,,percent of total billed charges,24% of total billed charges ,227.64,758.8,
CLIPPER BLADES SURGICAL,2501269,CDM,272,RC,,,Outpatient,,,55.5,27.75,,14.91,26.86,,,percent of total billed charges,26.86% of total billed charges,41.63,75,,,percent of total billed charges,75% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,13.32,24,,,percent of total billed charges,24% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,44.4,80,,,percent of total billed charges,80% of total billed charges ,13.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,27.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,13.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.91,26.86,,,percent of total billed charges,26.86% of total billed charges,13.32,24,,,percent of total billed charges,24% of total billed charges ,17.32,31.2,,,percent of total billed charges,31.2% of total billed charges,44.4,80,,,percent of total billed charges,80% of total billed charges,13.32,24,,,percent of total billed charges,24% of total billed charges ,13.32,24,,,percent of total billed charges,24% of total billed charges ,13.32,44.4,
VAGINAL PACKING,2501287,CDM,272,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
VEST RESTRAINT XL,2501290,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
ATLAS BALLOON AT75144,2501294,CDM,278,RC,C1725,HCPCS,Outpatient,,,2384.5,1192.25,,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1907.6,80,,,percent of total billed charges,80% of total billed charges ,578,24.24,,,percent of total billed charges,24.24% of total billed charges ,1201.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,583.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,743.96,31.2,,,percent of total billed charges,31.2% of total billed charges,1907.6,80,,,percent of total billed charges,80% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,1907.6,
ATLAS BALLOON AT75124,2501295,CDM,278,RC,C1725,HCPCS,Outpatient,,,1523.5,761.75,,409.21,26.86,,,percent of total billed charges,26.86% of total billed charges,1142.63,75,,,percent of total billed charges,75% of total billed charges ,1142.63,75,,,percent of total billed charges,75% of total billed charges ,365.64,24,,,percent of total billed charges,24% of total billed charges ,1142.63,75,,,percent of total billed charges,75% of total billed charges ,1142.63,75,,,percent of total billed charges,75% of total billed charges ,1218.8,80,,,percent of total billed charges,80% of total billed charges ,369.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,767.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,1142.63,75,,,percent of total billed charges,75% of total billed charges ,372.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,409.21,26.86,,,percent of total billed charges,26.86% of total billed charges,365.64,24,,,percent of total billed charges,24% of total billed charges ,475.33,31.2,,,percent of total billed charges,31.2% of total billed charges,1218.8,80,,,percent of total billed charges,80% of total billed charges,365.64,24,,,percent of total billed charges,24% of total billed charges ,365.64,24,,,percent of total billed charges,24% of total billed charges ,365.64,1218.8,
PEANUT SPONGE,2501296,CDM,270,RC,,,Outpatient,,,36,18,,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,28.8,80,,,percent of total billed charges,80% of total billed charges ,8.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,11.23,31.2,,,percent of total billed charges,31.2% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,28.8,
FLOW TRON,2501303,CDM,270,RC,,,Outpatient,,,270,135,,72.52,26.86,,,percent of total billed charges,26.86% of total billed charges,202.5,75,,,percent of total billed charges,75% of total billed charges ,202.5,75,,,percent of total billed charges,75% of total billed charges ,64.8,24,,,percent of total billed charges,24% of total billed charges ,202.5,75,,,percent of total billed charges,75% of total billed charges ,202.5,75,,,percent of total billed charges,75% of total billed charges ,216,80,,,percent of total billed charges,80% of total billed charges ,65.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,136.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,202.5,75,,,percent of total billed charges,75% of total billed charges ,66.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,72.52,26.86,,,percent of total billed charges,26.86% of total billed charges,64.8,24,,,percent of total billed charges,24% of total billed charges ,84.24,31.2,,,percent of total billed charges,31.2% of total billed charges,216,80,,,percent of total billed charges,80% of total billed charges,64.8,24,,,percent of total billed charges,24% of total billed charges ,64.8,24,,,percent of total billed charges,24% of total billed charges ,64.8,216,
GRIPPER NEEDLE 20 11/4,2501304,CDM,272,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
LIGAMAX CA500,2501325,CDM,272,RC,,,Outpatient,,,1105,552.5,,296.8,26.86,,,percent of total billed charges,26.86% of total billed charges,828.75,75,,,percent of total billed charges,75% of total billed charges ,828.75,75,,,percent of total billed charges,75% of total billed charges ,265.2,24,,,percent of total billed charges,24% of total billed charges ,828.75,75,,,percent of total billed charges,75% of total billed charges ,828.75,75,,,percent of total billed charges,75% of total billed charges ,884,80,,,percent of total billed charges,80% of total billed charges ,267.85,24.24,,,percent of total billed charges,24.24% of total billed charges ,556.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,828.75,75,,,percent of total billed charges,75% of total billed charges ,270.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,296.8,26.86,,,percent of total billed charges,26.86% of total billed charges,265.2,24,,,percent of total billed charges,24% of total billed charges ,344.76,31.2,,,percent of total billed charges,31.2% of total billed charges,884,80,,,percent of total billed charges,80% of total billed charges,265.2,24,,,percent of total billed charges,24% of total billed charges ,265.2,24,,,percent of total billed charges,24% of total billed charges ,265.2,884,
EPISTAT NASAL CATH KIT,2501333,CDM,270,RC,,,Outpatient,,,533.5,266.75,,143.3,26.86,,,percent of total billed charges,26.86% of total billed charges,400.13,75,,,percent of total billed charges,75% of total billed charges ,400.13,75,,,percent of total billed charges,75% of total billed charges ,128.04,24,,,percent of total billed charges,24% of total billed charges ,400.13,75,,,percent of total billed charges,75% of total billed charges ,400.13,75,,,percent of total billed charges,75% of total billed charges ,426.8,80,,,percent of total billed charges,80% of total billed charges ,129.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,268.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,400.13,75,,,percent of total billed charges,75% of total billed charges ,130.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,143.3,26.86,,,percent of total billed charges,26.86% of total billed charges,128.04,24,,,percent of total billed charges,24% of total billed charges ,166.45,31.2,,,percent of total billed charges,31.2% of total billed charges,426.8,80,,,percent of total billed charges,80% of total billed charges,128.04,24,,,percent of total billed charges,24% of total billed charges ,128.04,24,,,percent of total billed charges,24% of total billed charges ,128.04,426.8,
MINI ACCESS KIT 5FR.,2501337,CDM,272,RC,,,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
ADULT SLIPPERS XXL,2501339,CDM,270,RC,,,Outpatient,,,8,4,,2.15,26.86,,,percent of total billed charges,26.86% of total billed charges,6,75,,,percent of total billed charges,75% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,6.4,80,,,percent of total billed charges,80% of total billed charges ,1.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.15,26.86,,,percent of total billed charges,26.86% of total billed charges,1.92,24,,,percent of total billed charges,24% of total billed charges ,2.5,31.2,,,percent of total billed charges,31.2% of total billed charges,6.4,80,,,percent of total billed charges,80% of total billed charges,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,6.4,
PATIENT CHAIR PAD,2501342,CDM,270,RC,,,Outpatient,,,96,48,,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,76.8,
MAJOR LAP PACK (NEW),2501346,CDM,272,RC,,,Outpatient,,,374,187,,100.46,26.86,,,percent of total billed charges,26.86% of total billed charges,280.5,75,,,percent of total billed charges,75% of total billed charges ,280.5,75,,,percent of total billed charges,75% of total billed charges ,89.76,24,,,percent of total billed charges,24% of total billed charges ,280.5,75,,,percent of total billed charges,75% of total billed charges ,280.5,75,,,percent of total billed charges,75% of total billed charges ,299.2,80,,,percent of total billed charges,80% of total billed charges ,90.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,188.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,280.5,75,,,percent of total billed charges,75% of total billed charges ,91.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,100.46,26.86,,,percent of total billed charges,26.86% of total billed charges,89.76,24,,,percent of total billed charges,24% of total billed charges ,116.69,31.2,,,percent of total billed charges,31.2% of total billed charges,299.2,80,,,percent of total billed charges,80% of total billed charges,89.76,24,,,percent of total billed charges,24% of total billed charges ,89.76,24,,,percent of total billed charges,24% of total billed charges ,89.76,299.2,
IV BASIC SOL. SET 2C8425,2501365,CDM,270,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
STRAIGHT TYPE BLOOD SET 2C,2501366,CDM,270,RC,,,Outpatient,,,116.5,58.25,,31.29,26.86,,,percent of total billed charges,26.86% of total billed charges,87.38,75,,,percent of total billed charges,75% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,27.96,24,,,percent of total billed charges,24% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,93.2,80,,,percent of total billed charges,80% of total billed charges ,28.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,58.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,28.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.29,26.86,,,percent of total billed charges,26.86% of total billed charges,27.96,24,,,percent of total billed charges,24% of total billed charges ,36.35,31.2,,,percent of total billed charges,31.2% of total billed charges,93.2,80,,,percent of total billed charges,80% of total billed charges,27.96,24,,,percent of total billed charges,24% of total billed charges ,27.96,24,,,percent of total billed charges,24% of total billed charges ,27.96,93.2,
IV BURETROL ADD-ON SET,2501367,CDM,272,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
IV CATH EXT.SET 2N3374,2501368,CDM,270,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
IV FILTER SET   10010454,2501370,CDM,270,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
IV CONT-FLO SET NON-VENTED 2C,2501371,CDM,270,RC,,,Outpatient,,,72,36,,19.34,26.86,,,percent of total billed charges,26.86% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.34,26.86,,,percent of total billed charges,26.86% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,57.6,
IV CONT-FLO VENTED 2C8541,2501372,CDM,270,RC,,,Outpatient,,,124.5,62.25,,33.44,26.86,,,percent of total billed charges,26.86% of total billed charges,93.38,75,,,percent of total billed charges,75% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,29.88,24,,,percent of total billed charges,24% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,99.6,80,,,percent of total billed charges,80% of total billed charges ,30.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,62.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,30.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,33.44,26.86,,,percent of total billed charges,26.86% of total billed charges,29.88,24,,,percent of total billed charges,24% of total billed charges ,38.84,31.2,,,percent of total billed charges,31.2% of total billed charges,99.6,80,,,percent of total billed charges,80% of total billed charges,29.88,24,,,percent of total billed charges,24% of total billed charges ,29.88,24,,,percent of total billed charges,24% of total billed charges ,29.88,99.6,
IV DIAL-A-FLO EXT.,2501373,CDM,270,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
IV SECONDARY MED SET 2C746,2501375,CDM,270,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
SENSI-TOUCH GLOVES 61/2,2501378,CDM,272,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
SENSI-TOUCH GLOVES 7.0,2501379,CDM,272,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
SENSI-TOUCH GLOVES 71/2,2501380,CDM,272,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
SENSI-TOUCH GLOVES 8.0,2501381,CDM,272,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
GASTROSTOMY TUBE 20FR.,2501390,CDM,272,RC,,,Outpatient,,,173,86.5,,46.47,26.86,,,percent of total billed charges,26.86% of total billed charges,129.75,75,,,percent of total billed charges,75% of total billed charges ,129.75,75,,,percent of total billed charges,75% of total billed charges ,41.52,24,,,percent of total billed charges,24% of total billed charges ,129.75,75,,,percent of total billed charges,75% of total billed charges ,129.75,75,,,percent of total billed charges,75% of total billed charges ,138.4,80,,,percent of total billed charges,80% of total billed charges ,41.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,87.19,50.4,,,percent of total billed charges,50.4% of total billed charges ,129.75,75,,,percent of total billed charges,75% of total billed charges ,42.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,46.47,26.86,,,percent of total billed charges,26.86% of total billed charges,41.52,24,,,percent of total billed charges,24% of total billed charges ,53.98,31.2,,,percent of total billed charges,31.2% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,41.52,24,,,percent of total billed charges,24% of total billed charges ,41.52,24,,,percent of total billed charges,24% of total billed charges ,41.52,138.4,
DIAPERS PULL-UP MED,2501394,CDM,270,RC,,,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
DIAPERS PULL-UP LG.,2501395,CDM,270,RC,,,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
DIAPERS PULL-UP XL,2501396,CDM,270,RC,,,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
SURE SEAL,2501397,CDM,270,RC,,,Outpatient,,,7,3.5,,1.88,26.86,,,percent of total billed charges,26.86% of total billed charges,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.6,80,,,percent of total billed charges,80% of total billed charges ,1.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,1.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.88,26.86,,,percent of total billed charges,26.86% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,2.18,31.2,,,percent of total billed charges,31.2% of total billed charges,5.6,80,,,percent of total billed charges,80% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,5.6,
CVP DRESSING TRAY,2501403,CDM,270,RC,,,Outpatient,,,179,89.5,,48.08,26.86,,,percent of total billed charges,26.86% of total billed charges,134.25,75,,,percent of total billed charges,75% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,42.96,24,,,percent of total billed charges,24% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,143.2,80,,,percent of total billed charges,80% of total billed charges ,43.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,90.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,43.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,48.08,26.86,,,percent of total billed charges,26.86% of total billed charges,42.96,24,,,percent of total billed charges,24% of total billed charges ,55.85,31.2,,,percent of total billed charges,31.2% of total billed charges,143.2,80,,,percent of total billed charges,80% of total billed charges,42.96,24,,,percent of total billed charges,24% of total billed charges ,42.96,24,,,percent of total billed charges,24% of total billed charges ,42.96,143.2,
DIALYSIS CATH 24CM,2501407,CDM,278,RC,C1876,HCPCS,Outpatient,,,1701.5,850.75,,457.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1276.13,75,,,percent of total billed charges,75% of total billed charges ,1276.13,75,,,percent of total billed charges,75% of total billed charges ,408.36,24,,,percent of total billed charges,24% of total billed charges ,1276.13,75,,,percent of total billed charges,75% of total billed charges ,1276.13,75,,,percent of total billed charges,75% of total billed charges ,1361.2,80,,,percent of total billed charges,80% of total billed charges ,412.44,24.24,,,percent of total billed charges,24.24% of total billed charges ,857.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,1276.13,75,,,percent of total billed charges,75% of total billed charges ,416.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,457.02,26.86,,,percent of total billed charges,26.86% of total billed charges,408.36,24,,,percent of total billed charges,24% of total billed charges ,530.87,31.2,,,percent of total billed charges,31.2% of total billed charges,1361.2,80,,,percent of total billed charges,80% of total billed charges,408.36,24,,,percent of total billed charges,24% of total billed charges ,408.36,24,,,percent of total billed charges,24% of total billed charges ,408.36,1361.2,
DIALYSIS CATH 28CM,2501408,CDM,278,RC,C1876,HCPCS,Outpatient,,,1701.5,850.75,,457.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1276.13,75,,,percent of total billed charges,75% of total billed charges ,1276.13,75,,,percent of total billed charges,75% of total billed charges ,408.36,24,,,percent of total billed charges,24% of total billed charges ,1276.13,75,,,percent of total billed charges,75% of total billed charges ,1276.13,75,,,percent of total billed charges,75% of total billed charges ,1361.2,80,,,percent of total billed charges,80% of total billed charges ,412.44,24.24,,,percent of total billed charges,24.24% of total billed charges ,857.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,1276.13,75,,,percent of total billed charges,75% of total billed charges ,416.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,457.02,26.86,,,percent of total billed charges,26.86% of total billed charges,408.36,24,,,percent of total billed charges,24% of total billed charges ,530.87,31.2,,,percent of total billed charges,31.2% of total billed charges,1361.2,80,,,percent of total billed charges,80% of total billed charges,408.36,24,,,percent of total billed charges,24% of total billed charges ,408.36,24,,,percent of total billed charges,24% of total billed charges ,408.36,1361.2,
DIALYSIS CATH 32CM,2501409,CDM,278,RC,C1876,HCPCS,Outpatient,,,1701.5,850.75,,457.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1276.13,75,,,percent of total billed charges,75% of total billed charges ,1276.13,75,,,percent of total billed charges,75% of total billed charges ,408.36,24,,,percent of total billed charges,24% of total billed charges ,1276.13,75,,,percent of total billed charges,75% of total billed charges ,1276.13,75,,,percent of total billed charges,75% of total billed charges ,1361.2,80,,,percent of total billed charges,80% of total billed charges ,412.44,24.24,,,percent of total billed charges,24.24% of total billed charges ,857.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,1276.13,75,,,percent of total billed charges,75% of total billed charges ,416.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,457.02,26.86,,,percent of total billed charges,26.86% of total billed charges,408.36,24,,,percent of total billed charges,24% of total billed charges ,530.87,31.2,,,percent of total billed charges,31.2% of total billed charges,1361.2,80,,,percent of total billed charges,80% of total billed charges,408.36,24,,,percent of total billed charges,24% of total billed charges ,408.36,24,,,percent of total billed charges,24% of total billed charges ,408.36,1361.2,
BENSON WIRE 145CM,2501412,CDM,272,RC,,,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
MICRO-INTRODUCER KIT,2501414,CDM,272,RC,,,Outpatient,,,214,107,,57.48,26.86,,,percent of total billed charges,26.86% of total billed charges,160.5,75,,,percent of total billed charges,75% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,51.36,24,,,percent of total billed charges,24% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,171.2,80,,,percent of total billed charges,80% of total billed charges ,51.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,52.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,57.48,26.86,,,percent of total billed charges,26.86% of total billed charges,51.36,24,,,percent of total billed charges,24% of total billed charges ,66.77,31.2,,,percent of total billed charges,31.2% of total billed charges,171.2,80,,,percent of total billed charges,80% of total billed charges,51.36,24,,,percent of total billed charges,24% of total billed charges ,51.36,24,,,percent of total billed charges,24% of total billed charges ,51.36,171.2,
SINGLE WALL NEEDLE,2501415,CDM,272,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
MULTI-TORQUE DEVICE,2501416,CDM,272,RC,,,Outpatient,,,122.5,61.25,,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,98,80,,,percent of total billed charges,80% of total billed charges ,29.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,38.22,31.2,,,percent of total billed charges,31.2% of total billed charges,98,80,,,percent of total billed charges,80% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,98,
TERUMO GLIDEWIRE STIFF,2501418,CDM,270,RC,,,Outpatient,,,551,275.5,,148,26.86,,,percent of total billed charges,26.86% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges ,413.25,75,,,percent of total billed charges,75% of total billed charges ,132.24,24,,,percent of total billed charges,24% of total billed charges ,413.25,75,,,percent of total billed charges,75% of total billed charges ,413.25,75,,,percent of total billed charges,75% of total billed charges ,440.8,80,,,percent of total billed charges,80% of total billed charges ,133.56,24.24,,,percent of total billed charges,24.24% of total billed charges ,277.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,413.25,75,,,percent of total billed charges,75% of total billed charges ,134.88,24.48,,,percent of total billed charges,24.48% of total billed charges ,148,26.86,,,percent of total billed charges,26.86% of total billed charges,132.24,24,,,percent of total billed charges,24% of total billed charges ,171.91,31.2,,,percent of total billed charges,31.2% of total billed charges,440.8,80,,,percent of total billed charges,80% of total billed charges,132.24,24,,,percent of total billed charges,24% of total billed charges ,132.24,24,,,percent of total billed charges,24% of total billed charges ,132.24,440.8,
COBAN 2 COMPRESSION SYSTEM,2501420,CDM,270,RC,,,Outpatient,,,42,21,,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,33.6,80,,,percent of total billed charges,80% of total billed charges ,10.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,13.1,31.2,,,percent of total billed charges,31.2% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,33.6,
CHLORAPREP 26ML.,2501423,CDM,270,RC,,,Outpatient,,,130,65,,34.92,26.86,,,percent of total billed charges,26.86% of total billed charges,97.5,75,,,percent of total billed charges,75% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,104,80,,,percent of total billed charges,80% of total billed charges ,31.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,65.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,34.92,26.86,,,percent of total billed charges,26.86% of total billed charges,31.2,24,,,percent of total billed charges,24% of total billed charges ,40.56,31.2,,,percent of total billed charges,31.2% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,31.2,24,,,percent of total billed charges,24% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,31.2,104,
TIP STOPS,2501425,CDM,270,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
I.V.CONN.EXTENSION SET,2501426,CDM,270,RC,,,Outpatient,,,40,20,,10.74,26.86,,,percent of total billed charges,26.86% of total billed charges,30,75,,,percent of total billed charges,75% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,9.6,24,,,percent of total billed charges,24% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,32,80,,,percent of total billed charges,80% of total billed charges ,9.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,9.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.74,26.86,,,percent of total billed charges,26.86% of total billed charges,9.6,24,,,percent of total billed charges,24% of total billed charges ,12.48,31.2,,,percent of total billed charges,31.2% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,9.6,24,,,percent of total billed charges,24% of total billed charges ,9.6,24,,,percent of total billed charges,24% of total billed charges ,9.6,32,
IV CONN CAP,2501427,CDM,270,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
DORADO BALLOONS DR80104,2501434,CDM,278,RC,C1725,HCPCS,Outpatient,,,2384.5,1192.25,,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1907.6,80,,,percent of total billed charges,80% of total billed charges ,578,24.24,,,percent of total billed charges,24.24% of total billed charges ,1201.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,583.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,743.96,31.2,,,percent of total billed charges,31.2% of total billed charges,1907.6,80,,,percent of total billed charges,80% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,1907.6,
DORADO BALLOONS DR8078,2501435,CDM,278,RC,C1725,HCPCS,Outpatient,,,2384.5,1192.25,,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1907.6,80,,,percent of total billed charges,80% of total billed charges ,578,24.24,,,percent of total billed charges,24.24% of total billed charges ,1201.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,583.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,743.96,31.2,,,percent of total billed charges,31.2% of total billed charges,1907.6,80,,,percent of total billed charges,80% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,1907.6,
DORADO BALLOON DR8088,2501436,CDM,278,RC,C1725,HCPCS,Outpatient,,,2384.5,1192.25,,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1907.6,80,,,percent of total billed charges,80% of total billed charges ,578,24.24,,,percent of total billed charges,24.24% of total billed charges ,1201.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,583.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,743.96,31.2,,,percent of total billed charges,31.2% of total billed charges,1907.6,80,,,percent of total billed charges,80% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,1907.6,
DORADO BALLOON DR8094,2501437,CDM,278,RC,C1725,HCPCS,Outpatient,,,2384.5,1192.25,,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1907.6,80,,,percent of total billed charges,80% of total billed charges ,578,24.24,,,percent of total billed charges,24.24% of total billed charges ,1201.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,583.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,743.96,31.2,,,percent of total billed charges,31.2% of total billed charges,1907.6,80,,,percent of total billed charges,80% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,1907.6,
DORADO BALLOON DR8064,2501438,CDM,278,RC,C1725,HCPCS,Outpatient,,,2384.5,1192.25,,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1907.6,80,,,percent of total billed charges,80% of total billed charges ,578,24.24,,,percent of total billed charges,24.24% of total billed charges ,1201.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,583.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,743.96,31.2,,,percent of total billed charges,31.2% of total billed charges,1907.6,80,,,percent of total billed charges,80% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,1907.6,
DORADO BALLOON DR8054,2501439,CDM,278,RC,C1725,HCPCS,Outpatient,,,2384.5,1192.25,,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1907.6,80,,,percent of total billed charges,80% of total billed charges ,578,24.24,,,percent of total billed charges,24.24% of total billed charges ,1201.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,583.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,743.96,31.2,,,percent of total billed charges,31.2% of total billed charges,1907.6,80,,,percent of total billed charges,80% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,1907.6,
DORADO BALLOON  DR8074,2501440,CDM,278,RC,C1725,HCPCS,Outpatient,,,2384.5,1192.25,,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1907.6,80,,,percent of total billed charges,80% of total billed charges ,578,24.24,,,percent of total billed charges,24.24% of total billed charges ,1201.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,583.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,743.96,31.2,,,percent of total billed charges,31.2% of total billed charges,1907.6,80,,,percent of total billed charges,80% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,1907.6,
DORADO BALLOON DR8084,2501441,CDM,278,RC,C1725,HCPCS,Outpatient,,,2384.5,1192.25,,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1907.6,80,,,percent of total billed charges,80% of total billed charges ,578,24.24,,,percent of total billed charges,24.24% of total billed charges ,1201.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,583.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,743.96,31.2,,,percent of total billed charges,31.2% of total billed charges,1907.6,80,,,percent of total billed charges,80% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,1907.6,
SINGLE BASIN SET,2501458,CDM,270,RC,,,Outpatient,,,26,13,,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,20.8,
SILVERSORB 1,2501466,CDM,272,RC,,,Outpatient,,,54.5,27.25,,14.64,26.86,,,percent of total billed charges,26.86% of total billed charges,40.88,75,,,percent of total billed charges,75% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,13.08,24,,,percent of total billed charges,24% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,43.6,80,,,percent of total billed charges,80% of total billed charges ,13.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,27.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,13.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.64,26.86,,,percent of total billed charges,26.86% of total billed charges,13.08,24,,,percent of total billed charges,24% of total billed charges ,17,31.2,,,percent of total billed charges,31.2% of total billed charges,43.6,80,,,percent of total billed charges,80% of total billed charges,13.08,24,,,percent of total billed charges,24% of total billed charges ,13.08,24,,,percent of total billed charges,24% of total billed charges ,13.08,43.6,
TERUMO GUIDEWIRE 25 GR2505,2501470,CDM,270,RC,,,Outpatient,,,551,275.5,,148,26.86,,,percent of total billed charges,26.86% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges ,413.25,75,,,percent of total billed charges,75% of total billed charges ,132.24,24,,,percent of total billed charges,24% of total billed charges ,413.25,75,,,percent of total billed charges,75% of total billed charges ,413.25,75,,,percent of total billed charges,75% of total billed charges ,440.8,80,,,percent of total billed charges,80% of total billed charges ,133.56,24.24,,,percent of total billed charges,24.24% of total billed charges ,277.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,413.25,75,,,percent of total billed charges,75% of total billed charges ,134.88,24.48,,,percent of total billed charges,24.48% of total billed charges ,148,26.86,,,percent of total billed charges,26.86% of total billed charges,132.24,24,,,percent of total billed charges,24% of total billed charges ,171.91,31.2,,,percent of total billed charges,31.2% of total billed charges,440.8,80,,,percent of total billed charges,80% of total billed charges,132.24,24,,,percent of total billed charges,24% of total billed charges ,132.24,24,,,percent of total billed charges,24% of total billed charges ,132.24,440.8,
DORADO BALLOON DR8044,2501471,CDM,278,RC,C1725,HCPCS,Outpatient,,,2384.5,1192.25,,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1907.6,80,,,percent of total billed charges,80% of total billed charges ,578,24.24,,,percent of total billed charges,24.24% of total billed charges ,1201.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,583.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,743.96,31.2,,,percent of total billed charges,31.2% of total billed charges,1907.6,80,,,percent of total billed charges,80% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,1907.6,
POST-OP SHOE PEDIATRIC,2501473,CDM,270,RC,,,Outpatient,,,105,52.5,,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.2,26.86,,,percent of total billed charges,26.86% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,84,
DORADO BALLOON DR8034,2501474,CDM,278,RC,C1725,HCPCS,Outpatient,,,2384.5,1192.25,,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,1907.6,80,,,percent of total billed charges,80% of total billed charges ,578,24.24,,,percent of total billed charges,24.24% of total billed charges ,1201.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,1788.38,75,,,percent of total billed charges,75% of total billed charges ,583.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,640.48,26.86,,,percent of total billed charges,26.86% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,743.96,31.2,,,percent of total billed charges,31.2% of total billed charges,1907.6,80,,,percent of total billed charges,80% of total billed charges,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,24,,,percent of total billed charges,24% of total billed charges ,572.28,1907.6,
PERCHIK BUTTON,2501504,CDM,272,RC,,,Outpatient,,,121.5,60.75,,32.63,26.86,,,percent of total billed charges,26.86% of total billed charges,91.13,75,,,percent of total billed charges,75% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,97.2,80,,,percent of total billed charges,80% of total billed charges ,29.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.63,26.86,,,percent of total billed charges,26.86% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,37.91,31.2,,,percent of total billed charges,31.2% of total billed charges,97.2,80,,,percent of total billed charges,80% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,97.2,
FALL RISK SOCKS LARGE,2501507,CDM,270,RC,,,Outpatient,,,10.5,5.25,,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,8.4,80,,,percent of total billed charges,80% of total billed charges ,2.55,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,3.28,31.2,,,percent of total billed charges,31.2% of total billed charges,8.4,80,,,percent of total billed charges,80% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,8.4,
FALL RISK KIT REGULAR,2501509,CDM,270,RC,,,Outpatient,,,154.5,77.25,,41.5,26.86,,,percent of total billed charges,26.86% of total billed charges,115.88,75,,,percent of total billed charges,75% of total billed charges ,115.88,75,,,percent of total billed charges,75% of total billed charges ,37.08,24,,,percent of total billed charges,24% of total billed charges ,115.88,75,,,percent of total billed charges,75% of total billed charges ,115.88,75,,,percent of total billed charges,75% of total billed charges ,123.6,80,,,percent of total billed charges,80% of total billed charges ,37.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,77.87,50.4,,,percent of total billed charges,50.4% of total billed charges ,115.88,75,,,percent of total billed charges,75% of total billed charges ,37.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,41.5,26.86,,,percent of total billed charges,26.86% of total billed charges,37.08,24,,,percent of total billed charges,24% of total billed charges ,48.2,31.2,,,percent of total billed charges,31.2% of total billed charges,123.6,80,,,percent of total billed charges,80% of total billed charges,37.08,24,,,percent of total billed charges,24% of total billed charges ,37.08,24,,,percent of total billed charges,24% of total billed charges ,37.08,123.6,
FALL RISK KIT LARGE,2501510,CDM,270,RC,,,Outpatient,,,154.5,77.25,,41.5,26.86,,,percent of total billed charges,26.86% of total billed charges,115.88,75,,,percent of total billed charges,75% of total billed charges ,115.88,75,,,percent of total billed charges,75% of total billed charges ,37.08,24,,,percent of total billed charges,24% of total billed charges ,115.88,75,,,percent of total billed charges,75% of total billed charges ,115.88,75,,,percent of total billed charges,75% of total billed charges ,123.6,80,,,percent of total billed charges,80% of total billed charges ,37.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,77.87,50.4,,,percent of total billed charges,50.4% of total billed charges ,115.88,75,,,percent of total billed charges,75% of total billed charges ,37.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,41.5,26.86,,,percent of total billed charges,26.86% of total billed charges,37.08,24,,,percent of total billed charges,24% of total billed charges ,48.2,31.2,,,percent of total billed charges,31.2% of total billed charges,123.6,80,,,percent of total billed charges,80% of total billed charges,37.08,24,,,percent of total billed charges,24% of total billed charges ,37.08,24,,,percent of total billed charges,24% of total billed charges ,37.08,123.6,
FALL RISK SLIPPERS LARGE,2501511,CDM,270,RC,,,Outpatient,,,40,20,,10.74,26.86,,,percent of total billed charges,26.86% of total billed charges,30,75,,,percent of total billed charges,75% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,9.6,24,,,percent of total billed charges,24% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,32,80,,,percent of total billed charges,80% of total billed charges ,9.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,9.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.74,26.86,,,percent of total billed charges,26.86% of total billed charges,9.6,24,,,percent of total billed charges,24% of total billed charges ,12.48,31.2,,,percent of total billed charges,31.2% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,9.6,24,,,percent of total billed charges,24% of total billed charges ,9.6,24,,,percent of total billed charges,24% of total billed charges ,9.6,32,
FALL RISK SLIPPERS MEDIUM,2501512,CDM,270,RC,,,Outpatient,,,91.5,45.75,,24.58,26.86,,,percent of total billed charges,26.86% of total billed charges,68.63,75,,,percent of total billed charges,75% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,21.96,24,,,percent of total billed charges,24% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,73.2,80,,,percent of total billed charges,80% of total billed charges ,22.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,46.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,22.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.58,26.86,,,percent of total billed charges,26.86% of total billed charges,21.96,24,,,percent of total billed charges,24% of total billed charges ,28.55,31.2,,,percent of total billed charges,31.2% of total billed charges,73.2,80,,,percent of total billed charges,80% of total billed charges,21.96,24,,,percent of total billed charges,24% of total billed charges ,21.96,24,,,percent of total billed charges,24% of total billed charges ,21.96,73.2,
FALL RISK SLIPPERS SMALL,2501514,CDM,270,RC,,,Outpatient,,,91.5,45.75,,24.58,26.86,,,percent of total billed charges,26.86% of total billed charges,68.63,75,,,percent of total billed charges,75% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,21.96,24,,,percent of total billed charges,24% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,73.2,80,,,percent of total billed charges,80% of total billed charges ,22.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,46.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,22.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.58,26.86,,,percent of total billed charges,26.86% of total billed charges,21.96,24,,,percent of total billed charges,24% of total billed charges ,28.55,31.2,,,percent of total billed charges,31.2% of total billed charges,73.2,80,,,percent of total billed charges,80% of total billed charges,21.96,24,,,percent of total billed charges,24% of total billed charges ,21.96,24,,,percent of total billed charges,24% of total billed charges ,21.96,73.2,
BUTTERFLY SETS 21GA.,2501518,CDM,270,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
IV SET MINI DRIP  OR 2C854,2501534,CDM,270,RC,,,Outpatient,,,124.5,62.25,,33.44,26.86,,,percent of total billed charges,26.86% of total billed charges,93.38,75,,,percent of total billed charges,75% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,29.88,24,,,percent of total billed charges,24% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,99.6,80,,,percent of total billed charges,80% of total billed charges ,30.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,62.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,30.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,33.44,26.86,,,percent of total billed charges,26.86% of total billed charges,29.88,24,,,percent of total billed charges,24% of total billed charges ,38.84,31.2,,,percent of total billed charges,31.2% of total billed charges,99.6,80,,,percent of total billed charges,80% of total billed charges,29.88,24,,,percent of total billed charges,24% of total billed charges ,29.88,24,,,percent of total billed charges,24% of total billed charges ,29.88,99.6,
QUIK-PACE ELECTRODES,2501544,CDM,270,RC,,,Outpatient,,,254.5,127.25,,68.36,26.86,,,percent of total billed charges,26.86% of total billed charges,190.88,75,,,percent of total billed charges,75% of total billed charges ,190.88,75,,,percent of total billed charges,75% of total billed charges ,61.08,24,,,percent of total billed charges,24% of total billed charges ,190.88,75,,,percent of total billed charges,75% of total billed charges ,190.88,75,,,percent of total billed charges,75% of total billed charges ,203.6,80,,,percent of total billed charges,80% of total billed charges ,61.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,128.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,190.88,75,,,percent of total billed charges,75% of total billed charges ,62.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,68.36,26.86,,,percent of total billed charges,26.86% of total billed charges,61.08,24,,,percent of total billed charges,24% of total billed charges ,79.4,31.2,,,percent of total billed charges,31.2% of total billed charges,203.6,80,,,percent of total billed charges,80% of total billed charges,61.08,24,,,percent of total billed charges,24% of total billed charges ,61.08,24,,,percent of total billed charges,24% of total billed charges ,61.08,203.6,
MEDIPORE DRESSING 3566,2501560,CDM,270,RC,,,Outpatient,,,7,3.5,,1.88,26.86,,,percent of total billed charges,26.86% of total billed charges,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.6,80,,,percent of total billed charges,80% of total billed charges ,1.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,1.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.88,26.86,,,percent of total billed charges,26.86% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,2.18,31.2,,,percent of total billed charges,31.2% of total billed charges,5.6,80,,,percent of total billed charges,80% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,5.6,
CYTOLOGY BRUSH,2501575,CDM,272,RC,,,Outpatient,,,83.5,41.75,,22.43,26.86,,,percent of total billed charges,26.86% of total billed charges,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.43,26.86,,,percent of total billed charges,26.86% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,66.8,
COBAN 2,2501585,CDM,270,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
PULSE OXISENSOR ADULT (OR),2501620,CDM,272,RC,,,Outpatient,,,110,55,,29.55,26.86,,,percent of total billed charges,26.86% of total billed charges,82.5,75,,,percent of total billed charges,75% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.55,26.86,,,percent of total billed charges,26.86% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,88,
FOLEY TRAY URINE METER 16F,2501636,CDM,272,RC,,,Outpatient,,,139,69.5,,37.34,26.86,,,percent of total billed charges,26.86% of total billed charges,104.25,75,,,percent of total billed charges,75% of total billed charges ,104.25,75,,,percent of total billed charges,75% of total billed charges ,33.36,24,,,percent of total billed charges,24% of total billed charges ,104.25,75,,,percent of total billed charges,75% of total billed charges ,104.25,75,,,percent of total billed charges,75% of total billed charges ,111.2,80,,,percent of total billed charges,80% of total billed charges ,33.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,70.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,104.25,75,,,percent of total billed charges,75% of total billed charges ,34.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.34,26.86,,,percent of total billed charges,26.86% of total billed charges,33.36,24,,,percent of total billed charges,24% of total billed charges ,43.37,31.2,,,percent of total billed charges,31.2% of total billed charges,111.2,80,,,percent of total billed charges,80% of total billed charges,33.36,24,,,percent of total billed charges,24% of total billed charges ,33.36,24,,,percent of total billed charges,24% of total billed charges ,33.36,111.2,
EXUDERM 2X2,2504004,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
STENT FLUENCY,2504005,CDM,278,RC,C1874,HCPCS,Outpatient,,,7216,3608,,1938.22,26.86,,,percent of total billed charges,26.86% of total billed charges,5412,75,,,percent of total billed charges,75% of total billed charges ,5412,75,,,percent of total billed charges,75% of total billed charges ,1731.84,24,,,percent of total billed charges,24% of total billed charges ,5412,75,,,percent of total billed charges,75% of total billed charges ,5412,75,,,percent of total billed charges,75% of total billed charges ,5772.8,80,,,percent of total billed charges,80% of total billed charges ,1749.16,24.24,,,percent of total billed charges,24.24% of total billed charges ,3636.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,5412,75,,,percent of total billed charges,75% of total billed charges ,1766.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,1938.22,26.86,,,percent of total billed charges,26.86% of total billed charges,1731.84,24,,,percent of total billed charges,24% of total billed charges ,2251.39,31.2,,,percent of total billed charges,31.2% of total billed charges,5772.8,80,,,percent of total billed charges,80% of total billed charges,1731.84,24,,,percent of total billed charges,24% of total billed charges ,1731.84,24,,,percent of total billed charges,24% of total billed charges ,1731.84,5772.8,
STENT LUMINEX,2504008,CDM,278,RC,C1874,HCPCS,Outpatient,,,4124,2062,,1107.71,26.86,,,percent of total billed charges,26.86% of total billed charges,3093,75,,,percent of total billed charges,75% of total billed charges ,3093,75,,,percent of total billed charges,75% of total billed charges ,989.76,24,,,percent of total billed charges,24% of total billed charges ,3093,75,,,percent of total billed charges,75% of total billed charges ,3093,75,,,percent of total billed charges,75% of total billed charges ,3299.2,80,,,percent of total billed charges,80% of total billed charges ,999.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,2078.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,3093,75,,,percent of total billed charges,75% of total billed charges ,1009.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,1107.71,26.86,,,percent of total billed charges,26.86% of total billed charges,989.76,24,,,percent of total billed charges,24% of total billed charges ,1286.69,31.2,,,percent of total billed charges,31.2% of total billed charges,3299.2,80,,,percent of total billed charges,80% of total billed charges,989.76,24,,,percent of total billed charges,24% of total billed charges ,989.76,24,,,percent of total billed charges,24% of total billed charges ,989.76,3299.2,
STENT LUMINEZ 10X60,2504009,CDM,278,RC,C1874,HCPCS,Outpatient,,,4124,2062,,1107.71,26.86,,,percent of total billed charges,26.86% of total billed charges,3093,75,,,percent of total billed charges,75% of total billed charges ,3093,75,,,percent of total billed charges,75% of total billed charges ,989.76,24,,,percent of total billed charges,24% of total billed charges ,3093,75,,,percent of total billed charges,75% of total billed charges ,3093,75,,,percent of total billed charges,75% of total billed charges ,3299.2,80,,,percent of total billed charges,80% of total billed charges ,999.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,2078.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,3093,75,,,percent of total billed charges,75% of total billed charges ,1009.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,1107.71,26.86,,,percent of total billed charges,26.86% of total billed charges,989.76,24,,,percent of total billed charges,24% of total billed charges ,1286.69,31.2,,,percent of total billed charges,31.2% of total billed charges,3299.2,80,,,percent of total billed charges,80% of total billed charges,989.76,24,,,percent of total billed charges,24% of total billed charges ,989.76,24,,,percent of total billed charges,24% of total billed charges ,989.76,3299.2,
STENT LUMINEX 8X40,2504012,CDM,278,RC,C1874,HCPCS,Outpatient,,,4124,2062,,1107.71,26.86,,,percent of total billed charges,26.86% of total billed charges,3093,75,,,percent of total billed charges,75% of total billed charges ,3093,75,,,percent of total billed charges,75% of total billed charges ,989.76,24,,,percent of total billed charges,24% of total billed charges ,3093,75,,,percent of total billed charges,75% of total billed charges ,3093,75,,,percent of total billed charges,75% of total billed charges ,3299.2,80,,,percent of total billed charges,80% of total billed charges ,999.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,2078.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,3093,75,,,percent of total billed charges,75% of total billed charges ,1009.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,1107.71,26.86,,,percent of total billed charges,26.86% of total billed charges,989.76,24,,,percent of total billed charges,24% of total billed charges ,1286.69,31.2,,,percent of total billed charges,31.2% of total billed charges,3299.2,80,,,percent of total billed charges,80% of total billed charges,989.76,24,,,percent of total billed charges,24% of total billed charges ,989.76,24,,,percent of total billed charges,24% of total billed charges ,989.76,3299.2,
STENT LUMINEX 8X60,2504013,CDM,278,RC,C1874,HCPCS,Outpatient,,,4124,2062,,1107.71,26.86,,,percent of total billed charges,26.86% of total billed charges,3093,75,,,percent of total billed charges,75% of total billed charges ,3093,75,,,percent of total billed charges,75% of total billed charges ,989.76,24,,,percent of total billed charges,24% of total billed charges ,3093,75,,,percent of total billed charges,75% of total billed charges ,3093,75,,,percent of total billed charges,75% of total billed charges ,3299.2,80,,,percent of total billed charges,80% of total billed charges ,999.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,2078.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,3093,75,,,percent of total billed charges,75% of total billed charges ,1009.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,1107.71,26.86,,,percent of total billed charges,26.86% of total billed charges,989.76,24,,,percent of total billed charges,24% of total billed charges ,1286.69,31.2,,,percent of total billed charges,31.2% of total billed charges,3299.2,80,,,percent of total billed charges,80% of total billed charges,989.76,24,,,percent of total billed charges,24% of total billed charges ,989.76,24,,,percent of total billed charges,24% of total billed charges ,989.76,3299.2,
STENT BARD FLAIR GRF,2504014,CDM,278,RC,C1874,HCPCS,Outpatient,,,10310.5,5155.25,,2769.4,26.86,,,percent of total billed charges,26.86% of total billed charges,7732.88,75,,,percent of total billed charges,75% of total billed charges ,7732.88,75,,,percent of total billed charges,75% of total billed charges ,2474.52,24,,,percent of total billed charges,24% of total billed charges ,7732.88,75,,,percent of total billed charges,75% of total billed charges ,7732.88,75,,,percent of total billed charges,75% of total billed charges ,8248.4,80,,,percent of total billed charges,80% of total billed charges ,2499.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,5196.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,7732.88,75,,,percent of total billed charges,75% of total billed charges ,2524.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,2769.4,26.86,,,percent of total billed charges,26.86% of total billed charges,2474.52,24,,,percent of total billed charges,24% of total billed charges ,3216.88,31.2,,,percent of total billed charges,31.2% of total billed charges,8248.4,80,,,percent of total billed charges,80% of total billed charges,2474.52,24,,,percent of total billed charges,24% of total billed charges ,2474.52,24,,,percent of total billed charges,24% of total billed charges ,2474.52,8248.4,
ENDOPATH TROCAR 5MM CTS02 SLEEVES,2504015,CDM,270,RC,,,Outpatient,,,293.5,146.75,,78.83,26.86,,,percent of total billed charges,26.86% of total billed charges,220.13,75,,,percent of total billed charges,75% of total billed charges ,220.13,75,,,percent of total billed charges,75% of total billed charges ,70.44,24,,,percent of total billed charges,24% of total billed charges ,220.13,75,,,percent of total billed charges,75% of total billed charges ,220.13,75,,,percent of total billed charges,75% of total billed charges ,234.8,80,,,percent of total billed charges,80% of total billed charges ,71.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,147.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,220.13,75,,,percent of total billed charges,75% of total billed charges ,71.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,78.83,26.86,,,percent of total billed charges,26.86% of total billed charges,70.44,24,,,percent of total billed charges,24% of total billed charges ,91.57,31.2,,,percent of total billed charges,31.2% of total billed charges,234.8,80,,,percent of total billed charges,80% of total billed charges,70.44,24,,,percent of total billed charges,24% of total billed charges ,70.44,24,,,percent of total billed charges,24% of total billed charges ,70.44,234.8,
ENDO KII BALLOON BLUNT COR47,2504016,CDM,270,RC,,,Outpatient,,,206,103,,55.33,26.86,,,percent of total billed charges,26.86% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,164.8,80,,,percent of total billed charges,80% of total billed charges ,49.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,103.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,50.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,55.33,26.86,,,percent of total billed charges,26.86% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,64.27,31.2,,,percent of total billed charges,31.2% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,164.8,
ENDOPATH DISSECTOR 5MM CY010,2504017,CDM,270,RC,,,Outpatient,,,469.5,234.75,,126.11,26.86,,,percent of total billed charges,26.86% of total billed charges,352.13,75,,,percent of total billed charges,75% of total billed charges ,352.13,75,,,percent of total billed charges,75% of total billed charges ,112.68,24,,,percent of total billed charges,24% of total billed charges ,352.13,75,,,percent of total billed charges,75% of total billed charges ,352.13,75,,,percent of total billed charges,75% of total billed charges ,375.6,80,,,percent of total billed charges,80% of total billed charges ,113.81,24.24,,,percent of total billed charges,24.24% of total billed charges ,236.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,352.13,75,,,percent of total billed charges,75% of total billed charges ,114.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,126.11,26.86,,,percent of total billed charges,26.86% of total billed charges,112.68,24,,,percent of total billed charges,24% of total billed charges ,146.48,31.2,,,percent of total billed charges,31.2% of total billed charges,375.6,80,,,percent of total billed charges,80% of total billed charges,112.68,24,,,percent of total billed charges,24% of total billed charges ,112.68,24,,,percent of total billed charges,24% of total billed charges ,112.68,375.6,
SUTURE SINGLE,2504018,CDM,270,RC,,,Outpatient,,,93.5,46.75,,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,74.8,80,,,percent of total billed charges,80% of total billed charges ,22.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,29.17,31.2,,,percent of total billed charges,31.2% of total billed charges,74.8,80,,,percent of total billed charges,80% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,74.8,
SUTURE MULTI DOUBLE  ENDED,2504019,CDM,270,RC,,,Outpatient,,,162.5,81.25,,43.65,26.86,,,percent of total billed charges,26.86% of total billed charges,121.88,75,,,percent of total billed charges,75% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,39,24,,,percent of total billed charges,24% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,130,80,,,percent of total billed charges,80% of total billed charges ,39.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,81.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,121.88,75,,,percent of total billed charges,75% of total billed charges ,39.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,43.65,26.86,,,percent of total billed charges,26.86% of total billed charges,39,24,,,percent of total billed charges,24% of total billed charges ,50.7,31.2,,,percent of total billed charges,31.2% of total billed charges,130,80,,,percent of total billed charges,80% of total billed charges,39,24,,,percent of total billed charges,24% of total billed charges ,39,24,,,percent of total billed charges,24% of total billed charges ,39,130,
EMPI FLEECE PADS,2504020,CDM,270,RC,,,Outpatient,,,226.5,113.25,,60.84,26.86,,,percent of total billed charges,26.86% of total billed charges,169.88,75,,,percent of total billed charges,75% of total billed charges ,169.88,75,,,percent of total billed charges,75% of total billed charges ,54.36,24,,,percent of total billed charges,24% of total billed charges ,169.88,75,,,percent of total billed charges,75% of total billed charges ,169.88,75,,,percent of total billed charges,75% of total billed charges ,181.2,80,,,percent of total billed charges,80% of total billed charges ,54.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,114.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,169.88,75,,,percent of total billed charges,75% of total billed charges ,55.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,60.84,26.86,,,percent of total billed charges,26.86% of total billed charges,54.36,24,,,percent of total billed charges,24% of total billed charges ,70.67,31.2,,,percent of total billed charges,31.2% of total billed charges,181.2,80,,,percent of total billed charges,80% of total billed charges,54.36,24,,,percent of total billed charges,24% of total billed charges ,54.36,24,,,percent of total billed charges,24% of total billed charges ,54.36,181.2,
MEDIHONEY GEL,2504021,CDM,270,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
MEDIHONEY 2X2 SHEET,2504022,CDM,270,RC,,,Outpatient,,,106,53,,28.47,26.86,,,percent of total billed charges,26.86% of total billed charges,79.5,75,,,percent of total billed charges,75% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,25.44,24,,,percent of total billed charges,24% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,84.8,80,,,percent of total billed charges,80% of total billed charges ,25.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,53.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,25.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.47,26.86,,,percent of total billed charges,26.86% of total billed charges,25.44,24,,,percent of total billed charges,24% of total billed charges ,33.07,31.2,,,percent of total billed charges,31.2% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,25.44,24,,,percent of total billed charges,24% of total billed charges ,25.44,24,,,percent of total billed charges,24% of total billed charges ,25.44,84.8,
ARTICULATING LINEAR CUTTER,2504024,CDM,272,RC,,,Outpatient,,,979.5,489.75,,263.09,26.86,,,percent of total billed charges,26.86% of total billed charges,734.63,75,,,percent of total billed charges,75% of total billed charges ,734.63,75,,,percent of total billed charges,75% of total billed charges ,235.08,24,,,percent of total billed charges,24% of total billed charges ,734.63,75,,,percent of total billed charges,75% of total billed charges ,734.63,75,,,percent of total billed charges,75% of total billed charges ,783.6,80,,,percent of total billed charges,80% of total billed charges ,237.43,24.24,,,percent of total billed charges,24.24% of total billed charges ,493.67,50.4,,,percent of total billed charges,50.4% of total billed charges ,734.63,75,,,percent of total billed charges,75% of total billed charges ,239.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,263.09,26.86,,,percent of total billed charges,26.86% of total billed charges,235.08,24,,,percent of total billed charges,24% of total billed charges ,305.6,31.2,,,percent of total billed charges,31.2% of total billed charges,783.6,80,,,percent of total billed charges,80% of total billed charges,235.08,24,,,percent of total billed charges,24% of total billed charges ,235.08,24,,,percent of total billed charges,24% of total billed charges ,235.08,783.6,
ANGIOJET AVX,2504025,CDM,270,RC,,,Outpatient,,,3616.5,1808.25,,971.39,26.86,,,percent of total billed charges,26.86% of total billed charges,2712.38,75,,,percent of total billed charges,75% of total billed charges ,2712.38,75,,,percent of total billed charges,75% of total billed charges ,867.96,24,,,percent of total billed charges,24% of total billed charges ,2712.38,75,,,percent of total billed charges,75% of total billed charges ,2712.38,75,,,percent of total billed charges,75% of total billed charges ,2893.2,80,,,percent of total billed charges,80% of total billed charges ,876.64,24.24,,,percent of total billed charges,24.24% of total billed charges ,1822.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,2712.38,75,,,percent of total billed charges,75% of total billed charges ,885.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,971.39,26.86,,,percent of total billed charges,26.86% of total billed charges,867.96,24,,,percent of total billed charges,24% of total billed charges ,1128.35,31.2,,,percent of total billed charges,31.2% of total billed charges,2893.2,80,,,percent of total billed charges,80% of total billed charges,867.96,24,,,percent of total billed charges,24% of total billed charges ,867.96,24,,,percent of total billed charges,24% of total billed charges ,867.96,2893.2,
ANGIOJET PROXI,2504026,CDM,270,RC,,,Outpatient,,,8840.5,4420.25,,2374.56,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,2121.72,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,7072.4,80,,,percent of total billed charges,80% of total billed charges ,2142.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,4455.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,6630.38,75,,,percent of total billed charges,75% of total billed charges ,2164.15,24.48,,,percent of total billed charges,24.48% of total billed charges ,2374.56,26.86,,,percent of total billed charges,26.86% of total billed charges,2121.72,24,,,percent of total billed charges,24% of total billed charges ,2758.24,31.2,,,percent of total billed charges,31.2% of total billed charges,7072.4,80,,,percent of total billed charges,80% of total billed charges,2121.72,24,,,percent of total billed charges,24% of total billed charges ,2121.72,24,,,percent of total billed charges,24% of total billed charges ,2121.72,7072.4,
ERBE PROBE,2504028,CDM,272,RC,,,Outpatient,,,776.5,388.25,,208.57,26.86,,,percent of total billed charges,26.86% of total billed charges,582.38,75,,,percent of total billed charges,75% of total billed charges ,582.38,75,,,percent of total billed charges,75% of total billed charges ,186.36,24,,,percent of total billed charges,24% of total billed charges ,582.38,75,,,percent of total billed charges,75% of total billed charges ,582.38,75,,,percent of total billed charges,75% of total billed charges ,621.2,80,,,percent of total billed charges,80% of total billed charges ,188.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,391.36,50.4,,,percent of total billed charges,50.4% of total billed charges ,582.38,75,,,percent of total billed charges,75% of total billed charges ,190.09,24.48,,,percent of total billed charges,24.48% of total billed charges ,208.57,26.86,,,percent of total billed charges,26.86% of total billed charges,186.36,24,,,percent of total billed charges,24% of total billed charges ,242.27,31.2,,,percent of total billed charges,31.2% of total billed charges,621.2,80,,,percent of total billed charges,80% of total billed charges,186.36,24,,,percent of total billed charges,24% of total billed charges ,186.36,24,,,percent of total billed charges,24% of total billed charges ,186.36,621.2,
MACROLYTE PAD,2504031,CDM,272,RC,,,Outpatient,,,110,55,,29.55,26.86,,,percent of total billed charges,26.86% of total billed charges,82.5,75,,,percent of total billed charges,75% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.55,26.86,,,percent of total billed charges,26.86% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,88,
ADULT BP CUFF,2504032,CDM,272,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
LARGE ADULT BP CUFF,2504033,CDM,272,RC,,,Outpatient,,,22.5,11.25,,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,18,
CHILD BP CUFF,2504034,CDM,272,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
SMALL ADULT BP CUFF,2504035,CDM,272,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
COVERDERM 4X14,2504036,CDM,272,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
COVERDERM 4X4,2504037,CDM,272,RC,,,Outpatient,,,10.5,5.25,,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,8.4,80,,,percent of total billed charges,80% of total billed charges ,2.55,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,3.28,31.2,,,percent of total billed charges,31.2% of total billed charges,8.4,80,,,percent of total billed charges,80% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,8.4,
3DMAX MESH LEFT LARGE,2504047,CDM,278,RC,C1781,HCPCS,Outpatient,,,1037,518.5,,278.54,26.86,,,percent of total billed charges,26.86% of total billed charges,777.75,75,,,percent of total billed charges,75% of total billed charges ,777.75,75,,,percent of total billed charges,75% of total billed charges ,248.88,24,,,percent of total billed charges,24% of total billed charges ,777.75,75,,,percent of total billed charges,75% of total billed charges ,777.75,75,,,percent of total billed charges,75% of total billed charges ,829.6,80,,,percent of total billed charges,80% of total billed charges ,251.37,24.24,,,percent of total billed charges,24.24% of total billed charges ,522.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,777.75,75,,,percent of total billed charges,75% of total billed charges ,253.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,278.54,26.86,,,percent of total billed charges,26.86% of total billed charges,248.88,24,,,percent of total billed charges,24% of total billed charges ,323.54,31.2,,,percent of total billed charges,31.2% of total billed charges,829.6,80,,,percent of total billed charges,80% of total billed charges,248.88,24,,,percent of total billed charges,24% of total billed charges ,248.88,24,,,percent of total billed charges,24% of total billed charges ,248.88,829.6,
VENTRALIGHT MESH 12X14,2504048,CDM,278,RC,C1781,HCPCS,Outpatient,,,7028.5,3514.25,,1887.86,26.86,,,percent of total billed charges,26.86% of total billed charges,5271.38,75,,,percent of total billed charges,75% of total billed charges ,5271.38,75,,,percent of total billed charges,75% of total billed charges ,1686.84,24,,,percent of total billed charges,24% of total billed charges ,5271.38,75,,,percent of total billed charges,75% of total billed charges ,5271.38,75,,,percent of total billed charges,75% of total billed charges ,5622.8,80,,,percent of total billed charges,80% of total billed charges ,1703.71,24.24,,,percent of total billed charges,24.24% of total billed charges ,3542.36,50.4,,,percent of total billed charges,50.4% of total billed charges ,5271.38,75,,,percent of total billed charges,75% of total billed charges ,1720.58,24.48,,,percent of total billed charges,24.48% of total billed charges ,1887.86,26.86,,,percent of total billed charges,26.86% of total billed charges,1686.84,24,,,percent of total billed charges,24% of total billed charges ,2192.89,31.2,,,percent of total billed charges,31.2% of total billed charges,5622.8,80,,,percent of total billed charges,80% of total billed charges,1686.84,24,,,percent of total billed charges,24% of total billed charges ,1686.84,24,,,percent of total billed charges,24% of total billed charges ,1686.84,5622.8,
BLUNT DISSECTOR 5MM BTD05,2504049,CDM,270,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
HARMONIC FOCUS CURVED 9CM,2504050,CDM,270,RC,,,Outpatient,,,1702.5,851.25,,457.29,26.86,,,percent of total billed charges,26.86% of total billed charges,1276.88,75,,,percent of total billed charges,75% of total billed charges ,1276.88,75,,,percent of total billed charges,75% of total billed charges ,408.6,24,,,percent of total billed charges,24% of total billed charges ,1276.88,75,,,percent of total billed charges,75% of total billed charges ,1276.88,75,,,percent of total billed charges,75% of total billed charges ,1362,80,,,percent of total billed charges,80% of total billed charges ,412.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,858.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,1276.88,75,,,percent of total billed charges,75% of total billed charges ,416.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,457.29,26.86,,,percent of total billed charges,26.86% of total billed charges,408.6,24,,,percent of total billed charges,24% of total billed charges ,531.18,31.2,,,percent of total billed charges,31.2% of total billed charges,1362,80,,,percent of total billed charges,80% of total billed charges,408.6,24,,,percent of total billed charges,24% of total billed charges ,408.6,24,,,percent of total billed charges,24% of total billed charges ,408.6,1362,
SPACEMAKER TM PRO,2504051,CDM,270,RC,,,Outpatient,,,1677,838.5,,450.44,26.86,,,percent of total billed charges,26.86% of total billed charges,1257.75,75,,,percent of total billed charges,75% of total billed charges ,1257.75,75,,,percent of total billed charges,75% of total billed charges ,402.48,24,,,percent of total billed charges,24% of total billed charges ,1257.75,75,,,percent of total billed charges,75% of total billed charges ,1257.75,75,,,percent of total billed charges,75% of total billed charges ,1341.6,80,,,percent of total billed charges,80% of total billed charges ,406.5,24.24,,,percent of total billed charges,24.24% of total billed charges ,845.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,1257.75,75,,,percent of total billed charges,75% of total billed charges ,410.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,450.44,26.86,,,percent of total billed charges,26.86% of total billed charges,402.48,24,,,percent of total billed charges,24% of total billed charges ,523.22,31.2,,,percent of total billed charges,31.2% of total billed charges,1341.6,80,,,percent of total billed charges,80% of total billed charges,402.48,24,,,percent of total billed charges,24% of total billed charges ,402.48,24,,,percent of total billed charges,24% of total billed charges ,402.48,1341.6,
OXYMASK O2/ETCO,2504052,CDM,270,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
KUMAR CATH,2504053,CDM,270,RC,,,Outpatient,,,93.5,46.75,,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,74.8,80,,,percent of total billed charges,80% of total billed charges ,22.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,29.17,31.2,,,percent of total billed charges,31.2% of total billed charges,74.8,80,,,percent of total billed charges,80% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,74.8,
MAXORB EXTRA AG,2504054,CDM,272,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
SURGIMESH  WN,2504055,CDM,270,RC,C1781,HCPCS,Outpatient,,,1249,624.5,,335.48,26.86,,,percent of total billed charges,26.86% of total billed charges,936.75,75,,,percent of total billed charges,75% of total billed charges ,936.75,75,,,percent of total billed charges,75% of total billed charges ,299.76,24,,,percent of total billed charges,24% of total billed charges ,936.75,75,,,percent of total billed charges,75% of total billed charges ,936.75,75,,,percent of total billed charges,75% of total billed charges ,999.2,80,,,percent of total billed charges,80% of total billed charges ,302.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,629.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,936.75,75,,,percent of total billed charges,75% of total billed charges ,305.76,24.48,,,percent of total billed charges,24.48% of total billed charges ,335.48,26.86,,,percent of total billed charges,26.86% of total billed charges,299.76,24,,,percent of total billed charges,24% of total billed charges ,389.69,31.2,,,percent of total billed charges,31.2% of total billed charges,999.2,80,,,percent of total billed charges,80% of total billed charges,299.76,24,,,percent of total billed charges,24% of total billed charges ,299.76,24,,,percent of total billed charges,24% of total billed charges ,299.76,999.2,
SECURESTRP,2504056,CDM,272,RC,,,Outpatient,,,1547,773.5,,415.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1160.25,75,,,percent of total billed charges,75% of total billed charges ,1160.25,75,,,percent of total billed charges,75% of total billed charges ,371.28,24,,,percent of total billed charges,24% of total billed charges ,1160.25,75,,,percent of total billed charges,75% of total billed charges ,1160.25,75,,,percent of total billed charges,75% of total billed charges ,1237.6,80,,,percent of total billed charges,80% of total billed charges ,374.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,779.69,50.4,,,percent of total billed charges,50.4% of total billed charges ,1160.25,75,,,percent of total billed charges,75% of total billed charges ,378.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,415.52,26.86,,,percent of total billed charges,26.86% of total billed charges,371.28,24,,,percent of total billed charges,24% of total billed charges ,482.66,31.2,,,percent of total billed charges,31.2% of total billed charges,1237.6,80,,,percent of total billed charges,80% of total billed charges,371.28,24,,,percent of total billed charges,24% of total billed charges ,371.28,24,,,percent of total billed charges,24% of total billed charges ,371.28,1237.6,
FASTOUCH ABSORBABLE,2504057,CDM,272,RC,,,Outpatient,,,1061,530.5,,284.98,26.86,,,percent of total billed charges,26.86% of total billed charges,795.75,75,,,percent of total billed charges,75% of total billed charges ,795.75,75,,,percent of total billed charges,75% of total billed charges ,254.64,24,,,percent of total billed charges,24% of total billed charges ,795.75,75,,,percent of total billed charges,75% of total billed charges ,795.75,75,,,percent of total billed charges,75% of total billed charges ,848.8,80,,,percent of total billed charges,80% of total billed charges ,257.19,24.24,,,percent of total billed charges,24.24% of total billed charges ,534.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,795.75,75,,,percent of total billed charges,75% of total billed charges ,259.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,284.98,26.86,,,percent of total billed charges,26.86% of total billed charges,254.64,24,,,percent of total billed charges,24% of total billed charges ,331.03,31.2,,,percent of total billed charges,31.2% of total billed charges,848.8,80,,,percent of total billed charges,80% of total billed charges,254.64,24,,,percent of total billed charges,24% of total billed charges ,254.64,24,,,percent of total billed charges,24% of total billed charges ,254.64,848.8,
PICC LINE,2504058,CDM,272,RC,,,Outpatient,,,679,339.5,,182.38,26.86,,,percent of total billed charges,26.86% of total billed charges,509.25,75,,,percent of total billed charges,75% of total billed charges ,509.25,75,,,percent of total billed charges,75% of total billed charges ,162.96,24,,,percent of total billed charges,24% of total billed charges ,509.25,75,,,percent of total billed charges,75% of total billed charges ,509.25,75,,,percent of total billed charges,75% of total billed charges ,543.2,80,,,percent of total billed charges,80% of total billed charges ,164.59,24.24,,,percent of total billed charges,24.24% of total billed charges ,342.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,509.25,75,,,percent of total billed charges,75% of total billed charges ,166.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,182.38,26.86,,,percent of total billed charges,26.86% of total billed charges,162.96,24,,,percent of total billed charges,24% of total billed charges ,211.85,31.2,,,percent of total billed charges,31.2% of total billed charges,543.2,80,,,percent of total billed charges,80% of total billed charges,162.96,24,,,percent of total billed charges,24% of total billed charges ,162.96,24,,,percent of total billed charges,24% of total billed charges ,162.96,543.2,
LIGASURE,2504059,CDM,272,RC,,,Outpatient,,,1700.5,850.25,,456.75,26.86,,,percent of total billed charges,26.86% of total billed charges,1275.38,75,,,percent of total billed charges,75% of total billed charges ,1275.38,75,,,percent of total billed charges,75% of total billed charges ,408.12,24,,,percent of total billed charges,24% of total billed charges ,1275.38,75,,,percent of total billed charges,75% of total billed charges ,1275.38,75,,,percent of total billed charges,75% of total billed charges ,1360.4,80,,,percent of total billed charges,80% of total billed charges ,412.2,24.24,,,percent of total billed charges,24.24% of total billed charges ,857.05,50.4,,,percent of total billed charges,50.4% of total billed charges ,1275.38,75,,,percent of total billed charges,75% of total billed charges ,416.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,456.75,26.86,,,percent of total billed charges,26.86% of total billed charges,408.12,24,,,percent of total billed charges,24% of total billed charges ,530.56,31.2,,,percent of total billed charges,31.2% of total billed charges,1360.4,80,,,percent of total billed charges,80% of total billed charges,408.12,24,,,percent of total billed charges,24% of total billed charges ,408.12,24,,,percent of total billed charges,24% of total billed charges ,408.12,1360.4,
PROXIMATE LINEAR CUTTER TCT10,2504060,CDM,272,RC,,,Outpatient,,,456.5,228.25,,122.62,26.86,,,percent of total billed charges,26.86% of total billed charges,342.38,75,,,percent of total billed charges,75% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,109.56,24,,,percent of total billed charges,24% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,365.2,80,,,percent of total billed charges,80% of total billed charges ,110.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,230.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,111.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,122.62,26.86,,,percent of total billed charges,26.86% of total billed charges,109.56,24,,,percent of total billed charges,24% of total billed charges ,142.43,31.2,,,percent of total billed charges,31.2% of total billed charges,365.2,80,,,percent of total billed charges,80% of total billed charges,109.56,24,,,percent of total billed charges,24% of total billed charges ,109.56,24,,,percent of total billed charges,24% of total billed charges ,109.56,365.2,
ENDO CURVED CUTTER CS40G,2504061,CDM,272,RC,,,Outpatient,,,817,408.5,,219.45,26.86,,,percent of total billed charges,26.86% of total billed charges,612.75,75,,,percent of total billed charges,75% of total billed charges ,612.75,75,,,percent of total billed charges,75% of total billed charges ,196.08,24,,,percent of total billed charges,24% of total billed charges ,612.75,75,,,percent of total billed charges,75% of total billed charges ,612.75,75,,,percent of total billed charges,75% of total billed charges ,653.6,80,,,percent of total billed charges,80% of total billed charges ,198.04,24.24,,,percent of total billed charges,24.24% of total billed charges ,411.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,612.75,75,,,percent of total billed charges,75% of total billed charges ,200,24.48,,,percent of total billed charges,24.48% of total billed charges ,219.45,26.86,,,percent of total billed charges,26.86% of total billed charges,196.08,24,,,percent of total billed charges,24% of total billed charges ,254.9,31.2,,,percent of total billed charges,31.2% of total billed charges,653.6,80,,,percent of total billed charges,80% of total billed charges,196.08,24,,,percent of total billed charges,24% of total billed charges ,196.08,24,,,percent of total billed charges,24% of total billed charges ,196.08,653.6,
ENDO CURVED CUTTER CS40B,2504062,CDM,272,RC,,,Outpatient,,,817,408.5,,219.45,26.86,,,percent of total billed charges,26.86% of total billed charges,612.75,75,,,percent of total billed charges,75% of total billed charges ,612.75,75,,,percent of total billed charges,75% of total billed charges ,196.08,24,,,percent of total billed charges,24% of total billed charges ,612.75,75,,,percent of total billed charges,75% of total billed charges ,612.75,75,,,percent of total billed charges,75% of total billed charges ,653.6,80,,,percent of total billed charges,80% of total billed charges ,198.04,24.24,,,percent of total billed charges,24.24% of total billed charges ,411.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,612.75,75,,,percent of total billed charges,75% of total billed charges ,200,24.48,,,percent of total billed charges,24.48% of total billed charges ,219.45,26.86,,,percent of total billed charges,26.86% of total billed charges,196.08,24,,,percent of total billed charges,24% of total billed charges ,254.9,31.2,,,percent of total billed charges,31.2% of total billed charges,653.6,80,,,percent of total billed charges,80% of total billed charges,196.08,24,,,percent of total billed charges,24% of total billed charges ,196.08,24,,,percent of total billed charges,24% of total billed charges ,196.08,653.6,
ENDOSCOPIC ULTRASOUND FINE NEEDLE BIOPSY,2504063,CDM,272,RC,,,Outpatient,,,1246.5,623.25,,334.81,26.86,,,percent of total billed charges,26.86% of total billed charges,934.88,75,,,percent of total billed charges,75% of total billed charges ,934.88,75,,,percent of total billed charges,75% of total billed charges ,299.16,24,,,percent of total billed charges,24% of total billed charges ,934.88,75,,,percent of total billed charges,75% of total billed charges ,934.88,75,,,percent of total billed charges,75% of total billed charges ,997.2,80,,,percent of total billed charges,80% of total billed charges ,302.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,628.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,934.88,75,,,percent of total billed charges,75% of total billed charges ,305.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,334.81,26.86,,,percent of total billed charges,26.86% of total billed charges,299.16,24,,,percent of total billed charges,24% of total billed charges ,388.91,31.2,,,percent of total billed charges,31.2% of total billed charges,997.2,80,,,percent of total billed charges,80% of total billed charges,299.16,24,,,percent of total billed charges,24% of total billed charges ,299.16,24,,,percent of total billed charges,24% of total billed charges ,299.16,997.2,
ECHO TIP ULTRA CELLIAC NEEDLE,2504064,CDM,272,RC,,,Outpatient,,,503.5,251.75,,135.24,26.86,,,percent of total billed charges,26.86% of total billed charges,377.63,75,,,percent of total billed charges,75% of total billed charges ,377.63,75,,,percent of total billed charges,75% of total billed charges ,120.84,24,,,percent of total billed charges,24% of total billed charges ,377.63,75,,,percent of total billed charges,75% of total billed charges ,377.63,75,,,percent of total billed charges,75% of total billed charges ,402.8,80,,,percent of total billed charges,80% of total billed charges ,122.05,24.24,,,percent of total billed charges,24.24% of total billed charges ,253.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,377.63,75,,,percent of total billed charges,75% of total billed charges ,123.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,135.24,26.86,,,percent of total billed charges,26.86% of total billed charges,120.84,24,,,percent of total billed charges,24% of total billed charges ,157.09,31.2,,,percent of total billed charges,31.2% of total billed charges,402.8,80,,,percent of total billed charges,80% of total billed charges,120.84,24,,,percent of total billed charges,24% of total billed charges ,120.84,24,,,percent of total billed charges,24% of total billed charges ,120.84,402.8,
SURGIMESH  XB E2226 22X26,2504065,CDM,278,RC,C1781,HCPCS,Outpatient,,,7293.5,3646.75,,1959.03,26.86,,,percent of total billed charges,26.86% of total billed charges,5470.13,75,,,percent of total billed charges,75% of total billed charges ,5470.13,75,,,percent of total billed charges,75% of total billed charges ,1750.44,24,,,percent of total billed charges,24% of total billed charges ,5470.13,75,,,percent of total billed charges,75% of total billed charges ,5470.13,75,,,percent of total billed charges,75% of total billed charges ,5834.8,80,,,percent of total billed charges,80% of total billed charges ,1767.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,3675.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,5470.13,75,,,percent of total billed charges,75% of total billed charges ,1785.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,1959.03,26.86,,,percent of total billed charges,26.86% of total billed charges,1750.44,24,,,percent of total billed charges,24% of total billed charges ,2275.57,31.2,,,percent of total billed charges,31.2% of total billed charges,5834.8,80,,,percent of total billed charges,80% of total billed charges,1750.44,24,,,percent of total billed charges,24% of total billed charges ,1750.44,24,,,percent of total billed charges,24% of total billed charges ,1750.44,5834.8,
SURGIMESH TINTRA  CK10,2504066,CDM,270,RC,C1781,HCPCS,Outpatient,,,3605,1802.5,,968.3,26.86,,,percent of total billed charges,26.86% of total billed charges,2703.75,75,,,percent of total billed charges,75% of total billed charges ,2703.75,75,,,percent of total billed charges,75% of total billed charges ,865.2,24,,,percent of total billed charges,24% of total billed charges ,2703.75,75,,,percent of total billed charges,75% of total billed charges ,2703.75,75,,,percent of total billed charges,75% of total billed charges ,2884,80,,,percent of total billed charges,80% of total billed charges ,873.85,24.24,,,percent of total billed charges,24.24% of total billed charges ,1816.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,2703.75,75,,,percent of total billed charges,75% of total billed charges ,882.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,968.3,26.86,,,percent of total billed charges,26.86% of total billed charges,865.2,24,,,percent of total billed charges,24% of total billed charges ,1124.76,31.2,,,percent of total billed charges,31.2% of total billed charges,2884,80,,,percent of total billed charges,80% of total billed charges,865.2,24,,,percent of total billed charges,24% of total billed charges ,865.2,24,,,percent of total billed charges,24% of total billed charges ,865.2,2884,
SURGIMESH XB TINTRA 1522,2504067,CDM,278,RC,C1781,HCPCS,Outpatient,,,6498.5,3249.25,,1745.5,26.86,,,percent of total billed charges,26.86% of total billed charges,4873.88,75,,,percent of total billed charges,75% of total billed charges ,4873.88,75,,,percent of total billed charges,75% of total billed charges ,1559.64,24,,,percent of total billed charges,24% of total billed charges ,4873.88,75,,,percent of total billed charges,75% of total billed charges ,4873.88,75,,,percent of total billed charges,75% of total billed charges ,5198.8,80,,,percent of total billed charges,80% of total billed charges ,1575.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,3275.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,4873.88,75,,,percent of total billed charges,75% of total billed charges ,1590.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,1745.5,26.86,,,percent of total billed charges,26.86% of total billed charges,1559.64,24,,,percent of total billed charges,24% of total billed charges ,2027.53,31.2,,,percent of total billed charges,31.2% of total billed charges,5198.8,80,,,percent of total billed charges,80% of total billed charges,1559.64,24,,,percent of total billed charges,24% of total billed charges ,1559.64,24,,,percent of total billed charges,24% of total billed charges ,1559.64,5198.8,
RESCUE RAT TOOTH,2504068,CDM,272,RC,,,Outpatient,,,323.5,161.75,,86.89,26.86,,,percent of total billed charges,26.86% of total billed charges,242.63,75,,,percent of total billed charges,75% of total billed charges ,242.63,75,,,percent of total billed charges,75% of total billed charges ,77.64,24,,,percent of total billed charges,24% of total billed charges ,242.63,75,,,percent of total billed charges,75% of total billed charges ,242.63,75,,,percent of total billed charges,75% of total billed charges ,258.8,80,,,percent of total billed charges,80% of total billed charges ,78.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,163.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,242.63,75,,,percent of total billed charges,75% of total billed charges ,79.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,86.89,26.86,,,percent of total billed charges,26.86% of total billed charges,77.64,24,,,percent of total billed charges,24% of total billed charges ,100.93,31.2,,,percent of total billed charges,31.2% of total billed charges,258.8,80,,,percent of total billed charges,80% of total billed charges,77.64,24,,,percent of total billed charges,24% of total billed charges ,77.64,24,,,percent of total billed charges,24% of total billed charges ,77.64,258.8,
WALL FLEX DUODENAL STENT,2504069,CDM,272,RC,,,Outpatient,,,7311,3655.5,,1963.73,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,1754.64,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,5848.8,80,,,percent of total billed charges,80% of total billed charges ,1772.19,24.24,,,percent of total billed charges,24.24% of total billed charges ,3684.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,5483.25,75,,,percent of total billed charges,75% of total billed charges ,1789.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,1963.73,26.86,,,percent of total billed charges,26.86% of total billed charges,1754.64,24,,,percent of total billed charges,24% of total billed charges ,2281.03,31.2,,,percent of total billed charges,31.2% of total billed charges,5848.8,80,,,percent of total billed charges,80% of total billed charges,1754.64,24,,,percent of total billed charges,24% of total billed charges ,1754.64,24,,,percent of total billed charges,24% of total billed charges ,1754.64,5848.8,
WALLFLEX ESOPHAGEAL STENT,2504070,CDM,272,RC,,,Outpatient,,,7311,3655.5,,1963.73,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,1754.64,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,5848.8,80,,,percent of total billed charges,80% of total billed charges ,1772.19,24.24,,,percent of total billed charges,24.24% of total billed charges ,3684.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,5483.25,75,,,percent of total billed charges,75% of total billed charges ,1789.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,1963.73,26.86,,,percent of total billed charges,26.86% of total billed charges,1754.64,24,,,percent of total billed charges,24% of total billed charges ,2281.03,31.2,,,percent of total billed charges,31.2% of total billed charges,5848.8,80,,,percent of total billed charges,80% of total billed charges,1754.64,24,,,percent of total billed charges,24% of total billed charges ,1754.64,24,,,percent of total billed charges,24% of total billed charges ,1754.64,5848.8,
CLEVERLOCK,2504071,CDM,272,RC,,,Outpatient,,,404,202,,108.51,26.86,,,percent of total billed charges,26.86% of total billed charges,303,75,,,percent of total billed charges,75% of total billed charges ,303,75,,,percent of total billed charges,75% of total billed charges ,96.96,24,,,percent of total billed charges,24% of total billed charges ,303,75,,,percent of total billed charges,75% of total billed charges ,303,75,,,percent of total billed charges,75% of total billed charges ,323.2,80,,,percent of total billed charges,80% of total billed charges ,97.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,203.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,303,75,,,percent of total billed charges,75% of total billed charges ,98.9,24.48,,,percent of total billed charges,24.48% of total billed charges ,108.51,26.86,,,percent of total billed charges,26.86% of total billed charges,96.96,24,,,percent of total billed charges,24% of total billed charges ,126.05,31.2,,,percent of total billed charges,31.2% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,96.96,24,,,percent of total billed charges,24% of total billed charges ,96.96,24,,,percent of total billed charges,24% of total billed charges ,96.96,323.2,
ADVANIX DUODENAL 10X5,2504072,CDM,272,RC,,,Outpatient,,,530.5,265.25,,142.49,26.86,,,percent of total billed charges,26.86% of total billed charges,397.88,75,,,percent of total billed charges,75% of total billed charges ,397.88,75,,,percent of total billed charges,75% of total billed charges ,127.32,24,,,percent of total billed charges,24% of total billed charges ,397.88,75,,,percent of total billed charges,75% of total billed charges ,397.88,75,,,percent of total billed charges,75% of total billed charges ,424.4,80,,,percent of total billed charges,80% of total billed charges ,128.59,24.24,,,percent of total billed charges,24.24% of total billed charges ,267.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,397.88,75,,,percent of total billed charges,75% of total billed charges ,129.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,142.49,26.86,,,percent of total billed charges,26.86% of total billed charges,127.32,24,,,percent of total billed charges,24% of total billed charges ,165.52,31.2,,,percent of total billed charges,31.2% of total billed charges,424.4,80,,,percent of total billed charges,80% of total billed charges,127.32,24,,,percent of total billed charges,24% of total billed charges ,127.32,24,,,percent of total billed charges,24% of total billed charges ,127.32,424.4,
EXTRACTOR PRO RX,2504073,CDM,272,RC,,,Outpatient,,,279,139.5,,74.94,26.86,,,percent of total billed charges,26.86% of total billed charges,209.25,75,,,percent of total billed charges,75% of total billed charges ,209.25,75,,,percent of total billed charges,75% of total billed charges ,66.96,24,,,percent of total billed charges,24% of total billed charges ,209.25,75,,,percent of total billed charges,75% of total billed charges ,209.25,75,,,percent of total billed charges,75% of total billed charges ,223.2,80,,,percent of total billed charges,80% of total billed charges ,67.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,140.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,209.25,75,,,percent of total billed charges,75% of total billed charges ,68.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,74.94,26.86,,,percent of total billed charges,26.86% of total billed charges,66.96,24,,,percent of total billed charges,24% of total billed charges ,87.05,31.2,,,percent of total billed charges,31.2% of total billed charges,223.2,80,,,percent of total billed charges,80% of total billed charges,66.96,24,,,percent of total billed charges,24% of total billed charges ,66.96,24,,,percent of total billed charges,24% of total billed charges ,66.96,223.2,
INFLATION DEVICE ENCORE,2504074,CDM,272,RC,,,Outpatient,,,227.5,113.75,,61.11,26.86,,,percent of total billed charges,26.86% of total billed charges,170.63,75,,,percent of total billed charges,75% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,54.6,24,,,percent of total billed charges,24% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,182,80,,,percent of total billed charges,80% of total billed charges ,55.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,114.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,55.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,61.11,26.86,,,percent of total billed charges,26.86% of total billed charges,54.6,24,,,percent of total billed charges,24% of total billed charges ,70.98,31.2,,,percent of total billed charges,31.2% of total billed charges,182,80,,,percent of total billed charges,80% of total billed charges,54.6,24,,,percent of total billed charges,24% of total billed charges ,54.6,24,,,percent of total billed charges,24% of total billed charges ,54.6,182,
DREAMTOME RX 44,2504075,CDM,270,RC,,,Outpatient,,,695.5,347.75,,186.81,26.86,,,percent of total billed charges,26.86% of total billed charges,521.63,75,,,percent of total billed charges,75% of total billed charges ,521.63,75,,,percent of total billed charges,75% of total billed charges ,166.92,24,,,percent of total billed charges,24% of total billed charges ,521.63,75,,,percent of total billed charges,75% of total billed charges ,521.63,75,,,percent of total billed charges,75% of total billed charges ,556.4,80,,,percent of total billed charges,80% of total billed charges ,168.59,24.24,,,percent of total billed charges,24.24% of total billed charges ,350.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,521.63,75,,,percent of total billed charges,75% of total billed charges ,170.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,186.81,26.86,,,percent of total billed charges,26.86% of total billed charges,166.92,24,,,percent of total billed charges,24% of total billed charges ,217,31.2,,,percent of total billed charges,31.2% of total billed charges,556.4,80,,,percent of total billed charges,80% of total billed charges,166.92,24,,,percent of total billed charges,24% of total billed charges ,166.92,24,,,percent of total billed charges,24% of total billed charges ,166.92,556.4,
HURRICANE RX,2504076,CDM,270,RC,,,Outpatient,,,487,243.5,,130.81,26.86,,,percent of total billed charges,26.86% of total billed charges,365.25,75,,,percent of total billed charges,75% of total billed charges ,365.25,75,,,percent of total billed charges,75% of total billed charges ,116.88,24,,,percent of total billed charges,24% of total billed charges ,365.25,75,,,percent of total billed charges,75% of total billed charges ,365.25,75,,,percent of total billed charges,75% of total billed charges ,389.6,80,,,percent of total billed charges,80% of total billed charges ,118.05,24.24,,,percent of total billed charges,24.24% of total billed charges ,245.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,365.25,75,,,percent of total billed charges,75% of total billed charges ,119.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,130.81,26.86,,,percent of total billed charges,26.86% of total billed charges,116.88,24,,,percent of total billed charges,24% of total billed charges ,151.94,31.2,,,percent of total billed charges,31.2% of total billed charges,389.6,80,,,percent of total billed charges,80% of total billed charges,116.88,24,,,percent of total billed charges,24% of total billed charges ,116.88,24,,,percent of total billed charges,24% of total billed charges ,116.88,389.6,
RAPID REFILL,2504077,CDM,272,RC,,,Outpatient,,,80.5,40.25,,21.62,26.86,,,percent of total billed charges,26.86% of total billed charges,60.38,75,,,percent of total billed charges,75% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,19.32,24,,,percent of total billed charges,24% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,64.4,80,,,percent of total billed charges,80% of total billed charges ,19.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,40.57,50.4,,,percent of total billed charges,50.4% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,19.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.62,26.86,,,percent of total billed charges,26.86% of total billed charges,19.32,24,,,percent of total billed charges,24% of total billed charges ,25.12,31.2,,,percent of total billed charges,31.2% of total billed charges,64.4,80,,,percent of total billed charges,80% of total billed charges,19.32,24,,,percent of total billed charges,24% of total billed charges ,19.32,24,,,percent of total billed charges,24% of total billed charges ,19.32,64.4,
DIGNISHIELD STOOL MANAGEMENT,2504078,CDM,272,RC,,,Outpatient,,,236,118,,63.39,26.86,,,percent of total billed charges,26.86% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges ,177,75,,,percent of total billed charges,75% of total billed charges ,56.64,24,,,percent of total billed charges,24% of total billed charges ,177,75,,,percent of total billed charges,75% of total billed charges ,177,75,,,percent of total billed charges,75% of total billed charges ,188.8,80,,,percent of total billed charges,80% of total billed charges ,57.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,118.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,177,75,,,percent of total billed charges,75% of total billed charges ,57.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.39,26.86,,,percent of total billed charges,26.86% of total billed charges,56.64,24,,,percent of total billed charges,24% of total billed charges ,73.63,31.2,,,percent of total billed charges,31.2% of total billed charges,188.8,80,,,percent of total billed charges,80% of total billed charges,56.64,24,,,percent of total billed charges,24% of total billed charges ,56.64,24,,,percent of total billed charges,24% of total billed charges ,56.64,188.8,
MOUTHCARE KIT SUCTION,2504079,CDM,272,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
PULSE OXISENSOR ADULT NEW,2504080,CDM,272,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
PULSE OXISENSOR PEDIATRIC NEW,2504081,CDM,272,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
STOPCOCK LARGE BORE SET,2504082,CDM,272,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
LOOP RECORDER,2504083,CDM,278,RC,C1764,HCPCS,Outpatient,,,12996.5,6498.25,,3490.86,26.86,,,percent of total billed charges,26.86% of total billed charges,9747.38,75,,,percent of total billed charges,75% of total billed charges ,9747.38,75,,,percent of total billed charges,75% of total billed charges ,3119.16,24,,,percent of total billed charges,24% of total billed charges ,9747.38,75,,,percent of total billed charges,75% of total billed charges ,9747.38,75,,,percent of total billed charges,75% of total billed charges ,10397.2,80,,,percent of total billed charges,80% of total billed charges ,3150.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,6550.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,9747.38,75,,,percent of total billed charges,75% of total billed charges ,3181.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,3490.86,26.86,,,percent of total billed charges,26.86% of total billed charges,3119.16,24,,,percent of total billed charges,24% of total billed charges ,4054.91,31.2,,,percent of total billed charges,31.2% of total billed charges,10397.2,80,,,percent of total billed charges,80% of total billed charges,3119.16,24,,,percent of total billed charges,24% of total billed charges ,3119.16,24,,,percent of total billed charges,24% of total billed charges ,3119.16,10397.2,
SONOPLEX II 22X50MM,2504084,CDM,272,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
SONOFLEX II 20X120MM,2504085,CDM,272,RC,,,Outpatient,,,42,21,,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,33.6,80,,,percent of total billed charges,80% of total billed charges ,10.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,13.1,31.2,,,percent of total billed charges,31.2% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,33.6,
VOYANT MARYLAND FUSION,2504086,CDM,272,RC,,,Outpatient,,,1127,563.5,,302.71,26.86,,,percent of total billed charges,26.86% of total billed charges,845.25,75,,,percent of total billed charges,75% of total billed charges ,845.25,75,,,percent of total billed charges,75% of total billed charges ,270.48,24,,,percent of total billed charges,24% of total billed charges ,845.25,75,,,percent of total billed charges,75% of total billed charges ,845.25,75,,,percent of total billed charges,75% of total billed charges ,901.6,80,,,percent of total billed charges,80% of total billed charges ,273.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,568.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,845.25,75,,,percent of total billed charges,75% of total billed charges ,275.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,302.71,26.86,,,percent of total billed charges,26.86% of total billed charges,270.48,24,,,percent of total billed charges,24% of total billed charges ,351.62,31.2,,,percent of total billed charges,31.2% of total billed charges,901.6,80,,,percent of total billed charges,80% of total billed charges,270.48,24,,,percent of total billed charges,24% of total billed charges ,270.48,24,,,percent of total billed charges,24% of total billed charges ,270.48,901.6,
VOYANT OPEN FUSION,2504087,CDM,272,RC,,,Outpatient,,,1127,563.5,,302.71,26.86,,,percent of total billed charges,26.86% of total billed charges,845.25,75,,,percent of total billed charges,75% of total billed charges ,845.25,75,,,percent of total billed charges,75% of total billed charges ,270.48,24,,,percent of total billed charges,24% of total billed charges ,845.25,75,,,percent of total billed charges,75% of total billed charges ,845.25,75,,,percent of total billed charges,75% of total billed charges ,901.6,80,,,percent of total billed charges,80% of total billed charges ,273.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,568.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,845.25,75,,,percent of total billed charges,75% of total billed charges ,275.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,302.71,26.86,,,percent of total billed charges,26.86% of total billed charges,270.48,24,,,percent of total billed charges,24% of total billed charges ,351.62,31.2,,,percent of total billed charges,31.2% of total billed charges,901.6,80,,,percent of total billed charges,80% of total billed charges,270.48,24,,,percent of total billed charges,24% of total billed charges ,270.48,24,,,percent of total billed charges,24% of total billed charges ,270.48,901.6,
DIAPER ADULT XXL,2504088,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
DIAPER PULL-UP XXL,2504089,CDM,270,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
TRIPLE LUMEN 20FR.,2504090,CDM,278,RC,,,Outpatient,,,872.5,436.25,,234.35,26.86,,,percent of total billed charges,26.86% of total billed charges,654.38,75,,,percent of total billed charges,75% of total billed charges ,654.38,75,,,percent of total billed charges,75% of total billed charges ,209.4,24,,,percent of total billed charges,24% of total billed charges ,654.38,75,,,percent of total billed charges,75% of total billed charges ,654.38,75,,,percent of total billed charges,75% of total billed charges ,698,80,,,percent of total billed charges,80% of total billed charges ,211.49,24.24,,,percent of total billed charges,24.24% of total billed charges ,439.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,654.38,75,,,percent of total billed charges,75% of total billed charges ,213.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,234.35,26.86,,,percent of total billed charges,26.86% of total billed charges,209.4,24,,,percent of total billed charges,24% of total billed charges ,272.22,31.2,,,percent of total billed charges,31.2% of total billed charges,698,80,,,percent of total billed charges,80% of total billed charges,209.4,24,,,percent of total billed charges,24% of total billed charges ,209.4,24,,,percent of total billed charges,24% of total billed charges ,209.4,698,
PNEUMOTHORAX SET,2504091,CDM,278,RC,,,Outpatient,,,490.5,245.25,,131.75,26.86,,,percent of total billed charges,26.86% of total billed charges,490.5,75,,,percent of total billed charges,75% of total billed charges ,490.5,75,,,percent of total billed charges,75% of total billed charges ,117.72,24,,,percent of total billed charges,24% of total billed charges ,490.5,75,,,percent of total billed charges,75% of total billed charges ,490.5,75,,,percent of total billed charges,75% of total billed charges ,392.4,80,,,percent of total billed charges,80% of total billed charges ,118.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,247.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,367.88,75,,,percent of total billed charges,75% of total billed charges ,120.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,131.75,26.86,,,percent of total billed charges,26.86% of total billed charges,117.72,24,,,percent of total billed charges,24% of total billed charges ,153.04,31.2,,,percent of total billed charges,31.2% of total billed charges,392.4,80,,,percent of total billed charges,80% of total billed charges,117.72,24,,,percent of total billed charges,24% of total billed charges ,117.72,24,,,percent of total billed charges,24% of total billed charges ,117.72,490.5,
JAGTOME RX39,2504092,CDM,270,RC,,,Outpatient,,,1332,666,,357.78,26.86,,,percent of total billed charges,26.86% of total billed charges,999,75,,,percent of total billed charges,75% of total billed charges ,999,75,,,percent of total billed charges,75% of total billed charges ,319.68,24,,,percent of total billed charges,24% of total billed charges ,999,75,,,percent of total billed charges,75% of total billed charges ,999,75,,,percent of total billed charges,75% of total billed charges ,1065.6,80,,,percent of total billed charges,80% of total billed charges ,322.88,24.24,,,percent of total billed charges,24.24% of total billed charges ,671.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,999,75,,,percent of total billed charges,75% of total billed charges ,326.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,357.78,26.86,,,percent of total billed charges,26.86% of total billed charges,319.68,24,,,percent of total billed charges,24% of total billed charges ,415.58,31.2,,,percent of total billed charges,31.2% of total billed charges,1065.6,80,,,percent of total billed charges,80% of total billed charges,319.68,24,,,percent of total billed charges,24% of total billed charges ,319.68,24,,,percent of total billed charges,24% of total billed charges ,319.68,1065.6,
MICKEY GASTRO FEEDING TUBE 20FR.,2504093,CDM,270,RC,,,Outpatient,,,236,118,,63.39,26.86,,,percent of total billed charges,26.86% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges ,177,75,,,percent of total billed charges,75% of total billed charges ,56.64,24,,,percent of total billed charges,24% of total billed charges ,177,75,,,percent of total billed charges,75% of total billed charges ,177,75,,,percent of total billed charges,75% of total billed charges ,188.8,80,,,percent of total billed charges,80% of total billed charges ,57.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,118.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,177,75,,,percent of total billed charges,75% of total billed charges ,57.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.39,26.86,,,percent of total billed charges,26.86% of total billed charges,56.64,24,,,percent of total billed charges,24% of total billed charges ,73.63,31.2,,,percent of total billed charges,31.2% of total billed charges,188.8,80,,,percent of total billed charges,80% of total billed charges,56.64,24,,,percent of total billed charges,24% of total billed charges ,56.64,24,,,percent of total billed charges,24% of total billed charges ,56.64,188.8,
INTRODUCER KIT GASTRO FEEDING TUBE 24FR,2504094,CDM,270,RC,,,Outpatient,,,536.5,268.25,,144.1,26.86,,,percent of total billed charges,26.86% of total billed charges,402.38,75,,,percent of total billed charges,75% of total billed charges ,402.38,75,,,percent of total billed charges,75% of total billed charges ,128.76,24,,,percent of total billed charges,24% of total billed charges ,402.38,75,,,percent of total billed charges,75% of total billed charges ,402.38,75,,,percent of total billed charges,75% of total billed charges ,429.2,80,,,percent of total billed charges,80% of total billed charges ,130.05,24.24,,,percent of total billed charges,24.24% of total billed charges ,270.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,402.38,75,,,percent of total billed charges,75% of total billed charges ,131.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,144.1,26.86,,,percent of total billed charges,26.86% of total billed charges,128.76,24,,,percent of total billed charges,24% of total billed charges ,167.39,31.2,,,percent of total billed charges,31.2% of total billed charges,429.2,80,,,percent of total billed charges,80% of total billed charges,128.76,24,,,percent of total billed charges,24% of total billed charges ,128.76,24,,,percent of total billed charges,24% of total billed charges ,128.76,429.2,
SACRUM BORDER BUTTERFLY 16X20,2504095,CDM,272,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
SACRUM BORDER BUTTERFLY 22.1X24.9,2504096,CDM,272,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
TROCAR 5MM CFF03,2504097,CDM,278,RC,,,Outpatient,,,45.5,22.75,,12.22,26.86,,,percent of total billed charges,26.86% of total billed charges,45.5,75,,,percent of total billed charges,75% of total billed charges ,45.5,75,,,percent of total billed charges,75% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,45.5,75,,,percent of total billed charges,75% of total billed charges ,45.5,75,,,percent of total billed charges,75% of total billed charges ,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.22,26.86,,,percent of total billed charges,26.86% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,36.4,80,,,percent of total billed charges,80% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,45.5,
TROCAR SLEEVE CFS02,2504098,CDM,270,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ELBOW/HEEL PROTECTOR,2504099,CDM,278,RC,,,Outpatient,,,7,3.5,,1.88,26.86,,,percent of total billed charges,26.86% of total billed charges,7,75,,,percent of total billed charges,75% of total billed charges ,7,75,,,percent of total billed charges,75% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,7,75,,,percent of total billed charges,75% of total billed charges ,7,75,,,percent of total billed charges,75% of total billed charges ,5.6,80,,,percent of total billed charges,80% of total billed charges ,1.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,1.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.88,26.86,,,percent of total billed charges,26.86% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,2.18,31.2,,,percent of total billed charges,31.2% of total billed charges,5.6,80,,,percent of total billed charges,80% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,7,
MEDIPORE H 2,2504100,CDM,272,RC,,,Outpatient,,,5,2.5,,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,4,80,,,percent of total billed charges,80% of total billed charges ,1.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,2.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.56,31.2,,,percent of total billed charges,31.2% of total billed charges,4,80,,,percent of total billed charges,80% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,4,
MEDIPORE  H 4,2504101,CDM,272,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
MEDIPORE H 6,2504102,CDM,272,RC,,,Outpatient,,,13.5,6.75,,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.8,80,,,percent of total billed charges,80% of total billed charges ,3.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,4.21,31.2,,,percent of total billed charges,31.2% of total billed charges,10.8,80,,,percent of total billed charges,80% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,10.8,
ENDO KII SLEEVE 5X100 CFS02,2504103,CDM,278,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,21.5,75,,,percent of total billed charges,75% of total billed charges ,21.5,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,21.5,75,,,percent of total billed charges,75% of total billed charges ,21.5,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,21.5,
ENDO KII FIOS TROCAR CFF03,2504104,CDM,278,RC,,,Outpatient,,,45.5,22.75,,12.22,26.86,,,percent of total billed charges,26.86% of total billed charges,45.5,75,,,percent of total billed charges,75% of total billed charges ,45.5,75,,,percent of total billed charges,75% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,45.5,75,,,percent of total billed charges,75% of total billed charges ,45.5,75,,,percent of total billed charges,75% of total billed charges ,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.22,26.86,,,percent of total billed charges,26.86% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,36.4,80,,,percent of total billed charges,80% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,45.5,
RX LOCKING DEVICE,2504105,CDM,278,RC,,,Outpatient,,,402.5,201.25,,108.11,26.86,,,percent of total billed charges,26.86% of total billed charges,402.5,75,,,percent of total billed charges,75% of total billed charges ,402.5,75,,,percent of total billed charges,75% of total billed charges ,96.6,24,,,percent of total billed charges,24% of total billed charges ,402.5,75,,,percent of total billed charges,75% of total billed charges ,402.5,75,,,percent of total billed charges,75% of total billed charges ,322,80,,,percent of total billed charges,80% of total billed charges ,97.57,24.24,,,percent of total billed charges,24.24% of total billed charges ,202.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,301.88,75,,,percent of total billed charges,75% of total billed charges ,98.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,108.11,26.86,,,percent of total billed charges,26.86% of total billed charges,96.6,24,,,percent of total billed charges,24% of total billed charges ,125.58,31.2,,,percent of total billed charges,31.2% of total billed charges,322,80,,,percent of total billed charges,80% of total billed charges,96.6,24,,,percent of total billed charges,24% of total billed charges ,96.6,24,,,percent of total billed charges,24% of total billed charges ,96.6,402.5,
TRAPEZOID RX,2504106,CDM,278,RC,,,Outpatient,,,919,459.5,,246.84,26.86,,,percent of total billed charges,26.86% of total billed charges,689.25,75,,,percent of total billed charges,75% of total billed charges ,689.25,75,,,percent of total billed charges,75% of total billed charges ,220.56,24,,,percent of total billed charges,24% of total billed charges ,689.25,75,,,percent of total billed charges,75% of total billed charges ,689.25,75,,,percent of total billed charges,75% of total billed charges ,735.2,80,,,percent of total billed charges,80% of total billed charges ,222.77,24.24,,,percent of total billed charges,24.24% of total billed charges ,463.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,689.25,75,,,percent of total billed charges,75% of total billed charges ,224.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,246.84,26.86,,,percent of total billed charges,26.86% of total billed charges,220.56,24,,,percent of total billed charges,24% of total billed charges ,286.73,31.2,,,percent of total billed charges,31.2% of total billed charges,735.2,80,,,percent of total billed charges,80% of total billed charges,220.56,24,,,percent of total billed charges,24% of total billed charges ,220.56,24,,,percent of total billed charges,24% of total billed charges ,220.56,735.2,
PILL/CRUSHER,2504107,CDM,270,RC,,,Outpatient,,,11.5,5.75,,3.09,26.86,,,percent of total billed charges,26.86% of total billed charges,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,9.2,80,,,percent of total billed charges,80% of total billed charges ,2.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.09,26.86,,,percent of total billed charges,26.86% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,3.59,31.2,,,percent of total billed charges,31.2% of total billed charges,9.2,80,,,percent of total billed charges,80% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,9.2,
PEDIATRIC AMBU BAG,2504108,CDM,270,RC,,,Outpatient,,,58.5,29.25,,15.71,26.86,,,percent of total billed charges,26.86% of total billed charges,43.88,75,,,percent of total billed charges,75% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.71,26.86,,,percent of total billed charges,26.86% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,46.8,
SMART CAPNOLINE LINE,2504109,CDM,270,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
EPOC BGEM CREA TEST CARD,2504110,CDM,270,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
CORE BIOPSY INSTRUMENT MARQUEE,2504111,CDM,270,RC,,,Outpatient,,,595.5,297.75,,159.95,26.86,,,percent of total billed charges,26.86% of total billed charges,446.63,75,,,percent of total billed charges,75% of total billed charges ,446.63,75,,,percent of total billed charges,75% of total billed charges ,142.92,24,,,percent of total billed charges,24% of total billed charges ,446.63,75,,,percent of total billed charges,75% of total billed charges ,446.63,75,,,percent of total billed charges,75% of total billed charges ,476.4,80,,,percent of total billed charges,80% of total billed charges ,144.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,300.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,446.63,75,,,percent of total billed charges,75% of total billed charges ,145.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,159.95,26.86,,,percent of total billed charges,26.86% of total billed charges,142.92,24,,,percent of total billed charges,24% of total billed charges ,185.8,31.2,,,percent of total billed charges,31.2% of total billed charges,476.4,80,,,percent of total billed charges,80% of total billed charges,142.92,24,,,percent of total billed charges,24% of total billed charges ,142.92,24,,,percent of total billed charges,24% of total billed charges ,142.92,476.4,
ESOPHAGEAL STENT,2504113,CDM,278,RC,,,Outpatient,,,7032,3516,,1888.8,26.86,,,percent of total billed charges,26.86% of total billed charges,5274,75,,,percent of total billed charges,75% of total billed charges ,5274,75,,,percent of total billed charges,75% of total billed charges ,1687.68,24,,,percent of total billed charges,24% of total billed charges ,5274,75,,,percent of total billed charges,75% of total billed charges ,5274,75,,,percent of total billed charges,75% of total billed charges ,5625.6,80,,,percent of total billed charges,80% of total billed charges ,1704.56,24.24,,,percent of total billed charges,24.24% of total billed charges ,3544.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,5274,75,,,percent of total billed charges,75% of total billed charges ,1721.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,1888.8,26.86,,,percent of total billed charges,26.86% of total billed charges,1687.68,24,,,percent of total billed charges,24% of total billed charges ,2193.98,31.2,,,percent of total billed charges,31.2% of total billed charges,5625.6,80,,,percent of total billed charges,80% of total billed charges,1687.68,24,,,percent of total billed charges,24% of total billed charges ,1687.68,24,,,percent of total billed charges,24% of total billed charges ,1687.68,5625.6,
TRUGUIDE BIOPSY NEEDLE,2504114,CDM,270,RC,,,Outpatient,,,127.5,63.75,,34.25,26.86,,,percent of total billed charges,26.86% of total billed charges,95.63,75,,,percent of total billed charges,75% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,30.6,24,,,percent of total billed charges,24% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,102,80,,,percent of total billed charges,80% of total billed charges ,30.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,64.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,31.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,34.25,26.86,,,percent of total billed charges,26.86% of total billed charges,30.6,24,,,percent of total billed charges,24% of total billed charges ,39.78,31.2,,,percent of total billed charges,31.2% of total billed charges,102,80,,,percent of total billed charges,80% of total billed charges,30.6,24,,,percent of total billed charges,24% of total billed charges ,30.6,24,,,percent of total billed charges,24% of total billed charges ,30.6,102,
PULSE OXISENSOR INFANT,2504115,CDM,270,RC,,,Outpatient,,,30,15,,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,24,80,,,percent of total billed charges,80% of total billed charges ,7.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,,,percent of total billed charges,31.2% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,
BILE BAG SMALL,2504116,CDM,270,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
SURGICEL 4X8,2504117,CDM,272,RC,,,Outpatient,,,284.5,142.25,,76.42,26.86,,,percent of total billed charges,26.86% of total billed charges,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,76.42,26.86,,,percent of total billed charges,26.86% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,227.6,
TEMPERATURE SENSING FOLEY CATH,2504118,CDM,272,RC,,,Outpatient,,,140,70,,37.6,26.86,,,percent of total billed charges,26.86% of total billed charges,105,75,,,percent of total billed charges,75% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,33.6,24,,,percent of total billed charges,24% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,112,80,,,percent of total billed charges,80% of total billed charges ,33.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,70.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,34.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.6,26.86,,,percent of total billed charges,26.86% of total billed charges,33.6,24,,,percent of total billed charges,24% of total billed charges ,43.68,31.2,,,percent of total billed charges,31.2% of total billed charges,112,80,,,percent of total billed charges,80% of total billed charges,33.6,24,,,percent of total billed charges,24% of total billed charges ,33.6,24,,,percent of total billed charges,24% of total billed charges ,33.6,112,
AQUACEL AG 3.5X14,2504119,CDM,272,RC,,,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
AQUACEL AG 3.5X6,2504120,CDM,272,RC,,,Outpatient,,,74,37,,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,55.5,75,,,percent of total billed charges,75% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,59.2,80,,,percent of total billed charges,80% of total billed charges ,17.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,18.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,23.09,31.2,,,percent of total billed charges,31.2% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,59.2,
AQUACEL AG DRESSING.39X18,2504121,CDM,272,RC,,,Outpatient,,,74,37,,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,55.5,75,,,percent of total billed charges,75% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,59.2,80,,,percent of total billed charges,80% of total billed charges ,17.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,18.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,23.09,31.2,,,percent of total billed charges,31.2% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,59.2,
DREAMWIRE,2504122,CDM,270,RC,,,Outpatient,,,1198,599,,321.78,26.86,,,percent of total billed charges,26.86% of total billed charges,898.5,75,,,percent of total billed charges,75% of total billed charges ,898.5,75,,,percent of total billed charges,75% of total billed charges ,287.52,24,,,percent of total billed charges,24% of total billed charges ,898.5,75,,,percent of total billed charges,75% of total billed charges ,898.5,75,,,percent of total billed charges,75% of total billed charges ,958.4,80,,,percent of total billed charges,80% of total billed charges ,290.4,24.24,,,percent of total billed charges,24.24% of total billed charges ,603.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,898.5,75,,,percent of total billed charges,75% of total billed charges ,293.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,321.78,26.86,,,percent of total billed charges,26.86% of total billed charges,287.52,24,,,percent of total billed charges,24% of total billed charges ,373.78,31.2,,,percent of total billed charges,31.2% of total billed charges,958.4,80,,,percent of total billed charges,80% of total billed charges,287.52,24,,,percent of total billed charges,24% of total billed charges ,287.52,24,,,percent of total billed charges,24% of total billed charges ,287.52,958.4,
GEL PACK SYRINGE,2504128,CDM,272,RC,,,Outpatient,,,318.5,159.25,,85.55,26.86,,,percent of total billed charges,26.86% of total billed charges,238.88,75,,,percent of total billed charges,75% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,76.44,24,,,percent of total billed charges,24% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,254.8,80,,,percent of total billed charges,80% of total billed charges ,77.2,24.24,,,percent of total billed charges,24.24% of total billed charges ,160.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,77.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,85.55,26.86,,,percent of total billed charges,26.86% of total billed charges,76.44,24,,,percent of total billed charges,24% of total billed charges ,99.37,31.2,,,percent of total billed charges,31.2% of total billed charges,254.8,80,,,percent of total billed charges,80% of total billed charges,76.44,24,,,percent of total billed charges,24% of total billed charges ,76.44,24,,,percent of total billed charges,24% of total billed charges ,76.44,254.8,
LITHMUS PAPER,2504129,CDM,272,RC,,,Outpatient,,,108,54,,29.01,26.86,,,percent of total billed charges,26.86% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.01,26.86,,,percent of total billed charges,26.86% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,86.4,
CIRCULAR STAPLER XL SEALED ECS25B,2504130,CDM,272,RC,,,Outpatient,,,680,340,,182.65,26.86,,,percent of total billed charges,26.86% of total billed charges,510,75,,,percent of total billed charges,75% of total billed charges ,510,75,,,percent of total billed charges,75% of total billed charges ,163.2,24,,,percent of total billed charges,24% of total billed charges ,510,75,,,percent of total billed charges,75% of total billed charges ,510,75,,,percent of total billed charges,75% of total billed charges ,544,80,,,percent of total billed charges,80% of total billed charges ,164.83,24.24,,,percent of total billed charges,24.24% of total billed charges ,342.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,510,75,,,percent of total billed charges,75% of total billed charges ,166.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,182.65,26.86,,,percent of total billed charges,26.86% of total billed charges,163.2,24,,,percent of total billed charges,24% of total billed charges ,212.16,31.2,,,percent of total billed charges,31.2% of total billed charges,544,80,,,percent of total billed charges,80% of total billed charges,163.2,24,,,percent of total billed charges,24% of total billed charges ,163.2,24,,,percent of total billed charges,24% of total billed charges ,163.2,544,
CIRCULAR STAPLER XL SEALED ECS29B,2504131,CDM,272,RC,,,Outpatient,,,680,340,,182.65,26.86,,,percent of total billed charges,26.86% of total billed charges,510,75,,,percent of total billed charges,75% of total billed charges ,510,75,,,percent of total billed charges,75% of total billed charges ,163.2,24,,,percent of total billed charges,24% of total billed charges ,510,75,,,percent of total billed charges,75% of total billed charges ,510,75,,,percent of total billed charges,75% of total billed charges ,544,80,,,percent of total billed charges,80% of total billed charges ,164.83,24.24,,,percent of total billed charges,24.24% of total billed charges ,342.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,510,75,,,percent of total billed charges,75% of total billed charges ,166.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,182.65,26.86,,,percent of total billed charges,26.86% of total billed charges,163.2,24,,,percent of total billed charges,24% of total billed charges ,212.16,31.2,,,percent of total billed charges,31.2% of total billed charges,544,80,,,percent of total billed charges,80% of total billed charges,163.2,24,,,percent of total billed charges,24% of total billed charges ,163.2,24,,,percent of total billed charges,24% of total billed charges ,163.2,544,
AXIOS STENT 15MMX10MM,2504132,CDM,270,RC,,,Outpatient,,,15707.5,7853.75,,4219.03,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,3769.8,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,12566,80,,,percent of total billed charges,80% of total billed charges ,3807.5,24.24,,,percent of total billed charges,24.24% of total billed charges ,7916.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,11780.63,75,,,percent of total billed charges,75% of total billed charges ,3845.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,4219.03,26.86,,,percent of total billed charges,26.86% of total billed charges,3769.8,24,,,percent of total billed charges,24% of total billed charges ,4900.74,31.2,,,percent of total billed charges,31.2% of total billed charges,12566,80,,,percent of total billed charges,80% of total billed charges,3769.8,24,,,percent of total billed charges,24% of total billed charges ,3769.8,24,,,percent of total billed charges,24% of total billed charges ,3769.8,12566,
IOBAN 13X13,2504133,CDM,270,RC,,,Outpatient,,,8.5,4.25,,2.28,26.86,,,percent of total billed charges,26.86% of total billed charges,6.38,75,,,percent of total billed charges,75% of total billed charges ,6.38,75,,,percent of total billed charges,75% of total billed charges ,2.04,24,,,percent of total billed charges,24% of total billed charges ,6.38,75,,,percent of total billed charges,75% of total billed charges ,6.38,75,,,percent of total billed charges,75% of total billed charges ,6.8,80,,,percent of total billed charges,80% of total billed charges ,2.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,6.38,75,,,percent of total billed charges,75% of total billed charges ,2.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2.04,24,,,percent of total billed charges,24% of total billed charges ,2.65,31.2,,,percent of total billed charges,31.2% of total billed charges,6.8,80,,,percent of total billed charges,80% of total billed charges,2.04,24,,,percent of total billed charges,24% of total billed charges ,2.04,24,,,percent of total billed charges,24% of total billed charges ,2.04,6.8,
MEGADYNE NEEDLE ELECTRODE,2504134,CDM,270,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
HEATED BREATHING TUBE,2504135,CDM,270,RC,,,Outpatient,,,179,89.5,,48.08,26.86,,,percent of total billed charges,26.86% of total billed charges,134.25,75,,,percent of total billed charges,75% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,42.96,24,,,percent of total billed charges,24% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,143.2,80,,,percent of total billed charges,80% of total billed charges ,43.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,90.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,134.25,75,,,percent of total billed charges,75% of total billed charges ,43.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,48.08,26.86,,,percent of total billed charges,26.86% of total billed charges,42.96,24,,,percent of total billed charges,24% of total billed charges ,55.85,31.2,,,percent of total billed charges,31.2% of total billed charges,143.2,80,,,percent of total billed charges,80% of total billed charges,42.96,24,,,percent of total billed charges,24% of total billed charges ,42.96,24,,,percent of total billed charges,24% of total billed charges ,42.96,143.2,
NASAL CANNULA HI-FLOW,2504136,CDM,270,RC,,,Outpatient,,,66,33,,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,52.8,80,,,percent of total billed charges,80% of total billed charges ,16,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,16.16,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,20.59,31.2,,,percent of total billed charges,31.2% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,52.8,
FEMALE URINAL,2504143,CDM,272,RC,,,Outpatient,,,7,3.5,,1.88,26.86,,,percent of total billed charges,26.86% of total billed charges,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.6,80,,,percent of total billed charges,80% of total billed charges ,1.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,1.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.88,26.86,,,percent of total billed charges,26.86% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,2.18,31.2,,,percent of total billed charges,31.2% of total billed charges,5.6,80,,,percent of total billed charges,80% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,5.6,
LEGION BREAST NEEDLE,2504150,CDM,270,RC,,,Outpatient,,,63.5,31.75,,17.06,26.86,,,percent of total billed charges,26.86% of total billed charges,47.63,75,,,percent of total billed charges,75% of total billed charges ,47.63,75,,,percent of total billed charges,75% of total billed charges ,15.24,24,,,percent of total billed charges,24% of total billed charges ,47.63,75,,,percent of total billed charges,75% of total billed charges ,47.63,75,,,percent of total billed charges,75% of total billed charges ,50.8,80,,,percent of total billed charges,80% of total billed charges ,15.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,32,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.63,75,,,percent of total billed charges,75% of total billed charges ,15.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.06,26.86,,,percent of total billed charges,26.86% of total billed charges,15.24,24,,,percent of total billed charges,24% of total billed charges ,19.81,31.2,,,percent of total billed charges,31.2% of total billed charges,50.8,80,,,percent of total billed charges,80% of total billed charges,15.24,24,,,percent of total billed charges,24% of total billed charges ,15.24,24,,,percent of total billed charges,24% of total billed charges ,15.24,50.8,
HAWKINS II BREAST NEEDL,2504151,CDM,270,RC,,,Outpatient,,,59.5,29.75,,15.98,26.86,,,percent of total billed charges,26.86% of total billed charges,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.98,26.86,,,percent of total billed charges,26.86% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,47.6,
QUICKTRACH 4.0,2504152,CDM,270,RC,,,Outpatient,,,415,207.5,,111.47,26.86,,,percent of total billed charges,26.86% of total billed charges,311.25,75,,,percent of total billed charges,75% of total billed charges ,311.25,75,,,percent of total billed charges,75% of total billed charges ,99.6,24,,,percent of total billed charges,24% of total billed charges ,311.25,75,,,percent of total billed charges,75% of total billed charges ,311.25,75,,,percent of total billed charges,75% of total billed charges ,332,80,,,percent of total billed charges,80% of total billed charges ,100.6,24.24,,,percent of total billed charges,24.24% of total billed charges ,209.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,311.25,75,,,percent of total billed charges,75% of total billed charges ,101.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,111.47,26.86,,,percent of total billed charges,26.86% of total billed charges,99.6,24,,,percent of total billed charges,24% of total billed charges ,129.48,31.2,,,percent of total billed charges,31.2% of total billed charges,332,80,,,percent of total billed charges,80% of total billed charges,99.6,24,,,percent of total billed charges,24% of total billed charges ,99.6,24,,,percent of total billed charges,24% of total billed charges ,99.6,332,
QUICKTRACH 2.0,2504153,CDM,270,RC,,,Outpatient,,,415,207.5,,111.47,26.86,,,percent of total billed charges,26.86% of total billed charges,311.25,75,,,percent of total billed charges,75% of total billed charges ,311.25,75,,,percent of total billed charges,75% of total billed charges ,99.6,24,,,percent of total billed charges,24% of total billed charges ,311.25,75,,,percent of total billed charges,75% of total billed charges ,311.25,75,,,percent of total billed charges,75% of total billed charges ,332,80,,,percent of total billed charges,80% of total billed charges ,100.6,24.24,,,percent of total billed charges,24.24% of total billed charges ,209.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,311.25,75,,,percent of total billed charges,75% of total billed charges ,101.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,111.47,26.86,,,percent of total billed charges,26.86% of total billed charges,99.6,24,,,percent of total billed charges,24% of total billed charges ,129.48,31.2,,,percent of total billed charges,31.2% of total billed charges,332,80,,,percent of total billed charges,80% of total billed charges,99.6,24,,,percent of total billed charges,24% of total billed charges ,99.6,24,,,percent of total billed charges,24% of total billed charges ,99.6,332,
PANCREATIC STENT 10X5,2504155,CDM,270,RC,,,Outpatient,,,216.5,108.25,,58.15,26.86,,,percent of total billed charges,26.86% of total billed charges,162.38,75,,,percent of total billed charges,75% of total billed charges ,162.38,75,,,percent of total billed charges,75% of total billed charges ,51.96,24,,,percent of total billed charges,24% of total billed charges ,162.38,75,,,percent of total billed charges,75% of total billed charges ,162.38,75,,,percent of total billed charges,75% of total billed charges ,173.2,80,,,percent of total billed charges,80% of total billed charges ,52.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,109.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,162.38,75,,,percent of total billed charges,75% of total billed charges ,53,24.48,,,percent of total billed charges,24.48% of total billed charges ,58.15,26.86,,,percent of total billed charges,26.86% of total billed charges,51.96,24,,,percent of total billed charges,24% of total billed charges ,67.55,31.2,,,percent of total billed charges,31.2% of total billed charges,173.2,80,,,percent of total billed charges,80% of total billed charges,51.96,24,,,percent of total billed charges,24% of total billed charges ,51.96,24,,,percent of total billed charges,24% of total billed charges ,51.96,173.2,
PACREATIC INTRODUCER,2504156,CDM,270,RC,,,Outpatient,,,243.5,121.75,,65.4,26.86,,,percent of total billed charges,26.86% of total billed charges,182.63,75,,,percent of total billed charges,75% of total billed charges ,182.63,75,,,percent of total billed charges,75% of total billed charges ,58.44,24,,,percent of total billed charges,24% of total billed charges ,182.63,75,,,percent of total billed charges,75% of total billed charges ,182.63,75,,,percent of total billed charges,75% of total billed charges ,194.8,80,,,percent of total billed charges,80% of total billed charges ,59.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,122.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,182.63,75,,,percent of total billed charges,75% of total billed charges ,59.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,65.4,26.86,,,percent of total billed charges,26.86% of total billed charges,58.44,24,,,percent of total billed charges,24% of total billed charges ,75.97,31.2,,,percent of total billed charges,31.2% of total billed charges,194.8,80,,,percent of total billed charges,80% of total billed charges,58.44,24,,,percent of total billed charges,24% of total billed charges ,58.44,24,,,percent of total billed charges,24% of total billed charges ,58.44,194.8,
BODY WEDGE,2504157,CDM,270,RC,,,Outpatient,,,26,13,,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,20.8,
BARRIER CREAM CLOTH,2504158,CDM,270,RC,,,Outpatient,,,3.5,1.75,,0.94,26.86,,,percent of total billed charges,26.86% of total billed charges,2.63,75,,,percent of total billed charges,75% of total billed charges ,2.63,75,,,percent of total billed charges,75% of total billed charges ,0.84,24,,,percent of total billed charges,24% of total billed charges ,2.63,75,,,percent of total billed charges,75% of total billed charges ,2.63,75,,,percent of total billed charges,75% of total billed charges ,2.8,80,,,percent of total billed charges,80% of total billed charges ,0.85,24.24,,,percent of total billed charges,24.24% of total billed charges ,1.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,2.63,75,,,percent of total billed charges,75% of total billed charges ,0.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.94,26.86,,,percent of total billed charges,26.86% of total billed charges,0.84,24,,,percent of total billed charges,24% of total billed charges ,1.09,31.2,,,percent of total billed charges,31.2% of total billed charges,2.8,80,,,percent of total billed charges,80% of total billed charges,0.84,24,,,percent of total billed charges,24% of total billed charges ,0.84,24,,,percent of total billed charges,24% of total billed charges ,0.84,2.8,
FALL SLIPPER BARIATRIC,2504159,CDM,270,RC,,,Outpatient,,,6,3,,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.8,80,,,percent of total billed charges,80% of total billed charges ,1.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.87,31.2,,,percent of total billed charges,31.2% of total billed charges,4.8,80,,,percent of total billed charges,80% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,4.8,
MAD NASAL ATOMIZATION,2504160,CDM,270,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
PURACOL PLUS 4.2X4.5,2504161,CDM,270,RC,,,Outpatient,,,76,38,,20.41,26.86,,,percent of total billed charges,26.86% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges ,57,75,,,percent of total billed charges,75% of total billed charges ,18.24,24,,,percent of total billed charges,24% of total billed charges ,57,75,,,percent of total billed charges,75% of total billed charges ,57,75,,,percent of total billed charges,75% of total billed charges ,60.8,80,,,percent of total billed charges,80% of total billed charges ,18.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,38.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,57,75,,,percent of total billed charges,75% of total billed charges ,18.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.41,26.86,,,percent of total billed charges,26.86% of total billed charges,18.24,24,,,percent of total billed charges,24% of total billed charges ,23.71,31.2,,,percent of total billed charges,31.2% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,18.24,24,,,percent of total billed charges,24% of total billed charges ,18.24,24,,,percent of total billed charges,24% of total billed charges ,18.24,60.8,
EXUDERM SATIN 4X4,2504162,CDM,270,RC,,,Outpatient,,,10.5,5.25,,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,8.4,80,,,percent of total billed charges,80% of total billed charges ,2.55,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,3.28,31.2,,,percent of total billed charges,31.2% of total billed charges,8.4,80,,,percent of total billed charges,80% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,8.4,
MALE URINE SYSTEM,2504163,CDM,272,RC,,,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,41.2,
BALLOON 3,2504164,CDM,270,RC,,,Outpatient,,,56.5,28.25,,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
WALLFLEXESOPHAGEAL STENT 23X105,2504165,CDM,272,RC,,,Outpatient,,,6625.25,3312.63,,1779.54,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,1590.06,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,5300.2,80,,,percent of total billed charges,80% of total billed charges ,1605.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,3339.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,4968.94,75,,,percent of total billed charges,75% of total billed charges ,1621.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,1779.54,26.86,,,percent of total billed charges,26.86% of total billed charges,1590.06,24,,,percent of total billed charges,24% of total billed charges ,2067.08,31.2,,,percent of total billed charges,31.2% of total billed charges,5300.2,80,,,percent of total billed charges,80% of total billed charges,1590.06,24,,,percent of total billed charges,24% of total billed charges ,1590.06,24,,,percent of total billed charges,24% of total billed charges ,1590.06,5300.2,
PANCREATIC STENT 4X5,2504166,CDM,272,RC,,,Outpatient,,,236.25,118.13,,63.46,26.86,,,percent of total billed charges,26.86% of total billed charges,177.19,75,,,percent of total billed charges,75% of total billed charges ,177.19,75,,,percent of total billed charges,75% of total billed charges ,56.7,24,,,percent of total billed charges,24% of total billed charges ,177.19,75,,,percent of total billed charges,75% of total billed charges ,177.19,75,,,percent of total billed charges,75% of total billed charges ,189,80,,,percent of total billed charges,80% of total billed charges ,57.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.19,75,,,percent of total billed charges,75% of total billed charges ,57.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.46,26.86,,,percent of total billed charges,26.86% of total billed charges,56.7,24,,,percent of total billed charges,24% of total billed charges ,73.71,31.2,,,percent of total billed charges,31.2% of total billed charges,189,80,,,percent of total billed charges,80% of total billed charges,56.7,24,,,percent of total billed charges,24% of total billed charges ,56.7,24,,,percent of total billed charges,24% of total billed charges ,56.7,189,
OPTICELL AG 4X5,2504167,CDM,272,RC,,,Outpatient,,,14.46,7.23,,3.88,26.86,,,percent of total billed charges,26.86% of total billed charges,10.85,75,,,percent of total billed charges,75% of total billed charges ,10.85,75,,,percent of total billed charges,75% of total billed charges ,3.47,24,,,percent of total billed charges,24% of total billed charges ,10.85,75,,,percent of total billed charges,75% of total billed charges ,10.85,75,,,percent of total billed charges,75% of total billed charges ,11.57,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.85,75,,,percent of total billed charges,75% of total billed charges ,3.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.88,26.86,,,percent of total billed charges,26.86% of total billed charges,3.47,24,,,percent of total billed charges,24% of total billed charges ,4.51,31.2,,,percent of total billed charges,31.2% of total billed charges,11.57,80,,,percent of total billed charges,80% of total billed charges,3.47,24,,,percent of total billed charges,24% of total billed charges ,3.47,24,,,percent of total billed charges,24% of total billed charges ,3.47,11.57,
EAR SENSOR CLIP,2504168,CDM,272,RC,,,Outpatient,,,66,33,,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,52.8,80,,,percent of total billed charges,80% of total billed charges ,16,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,16.16,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,20.59,31.2,,,percent of total billed charges,31.2% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,52.8,
FLEXIBLE VIDEOSCOPE,2504169,CDM,272,RC,,,Outpatient,,,7250,3625,,1947.35,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,1740,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,5800,80,,,percent of total billed charges,80% of total billed charges ,1757.4,24.24,,,percent of total billed charges,24.24% of total billed charges ,3654,50.4,,,percent of total billed charges,50.4% of total billed charges ,5437.5,75,,,percent of total billed charges,75% of total billed charges ,1774.8,24.48,,,percent of total billed charges,24.48% of total billed charges ,1947.35,26.86,,,percent of total billed charges,26.86% of total billed charges,1740,24,,,percent of total billed charges,24% of total billed charges ,2262,31.2,,,percent of total billed charges,31.2% of total billed charges,5800,80,,,percent of total billed charges,80% of total billed charges,1740,24,,,percent of total billed charges,24% of total billed charges ,1740,24,,,percent of total billed charges,24% of total billed charges ,1740,5800,
INCISION AND DRAINAGE OF SUBMUCOSAL,2800001,CDM,521,RC,45005,HCPCS,Outpatient,,,563.5,281.75,,151.36,26.86,,,percent of total billed charges,26.86% of total billed charges,422.63,75,,,percent of total billed charges,75% of total billed charges ,422.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,422.63,75,,,percent of total billed charges,75% of total billed charges ,422.63,75,,,percent of total billed charges,75% of total billed charges ,450.8,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,284,50.4,,,percent of total billed charges,50.4% of total billed charges ,422.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,151.36,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,151.36,450.8,
INCISION AND DRAINAGE SHOULDER AREA DEEP,2800002,CDM,521,RC,10121,HCPCS,Outpatient,,,917.5,458.75,,246.44,26.86,,,percent of total billed charges,26.86% of total billed charges,688.13,75,,,percent of total billed charges,75% of total billed charges ,688.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,688.13,75,,,percent of total billed charges,75% of total billed charges ,688.13,75,,,percent of total billed charges,75% of total billed charges ,734,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,462.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,688.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,246.44,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,734,
"ENTERECTOMY, RESECTION OR SMALL INTESTI",2800003,CDM,521,RC,44120,HCPCS,Outpatient,,,4460,2230,,1197.96,26.86,,,percent of total billed charges,26.86% of total billed charges,3345,75,,,percent of total billed charges,75% of total billed charges ,3345,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,3345,75,,,percent of total billed charges,75% of total billed charges ,3345,75,,,percent of total billed charges,75% of total billed charges ,3568,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,2247.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,3345,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,1197.96,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,3568,
EXPLORATORY LAPAROTOMY EXPLORATORY CELIO,2800004,CDM,521,RC,49000,HCPCS,Outpatient,,,2800.5,1400.25,,752.21,26.86,,,percent of total billed charges,26.86% of total billed charges,2100.38,75,,,percent of total billed charges,75% of total billed charges ,2100.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,2100.38,75,,,percent of total billed charges,75% of total billed charges ,2100.38,75,,,percent of total billed charges,75% of total billed charges ,2240.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,1411.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,2100.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,752.21,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,2240.4,
EXCISION MALIGNANT LESION INCLUDING MARG,2800005,CDM,521,RC,11640,HCPCS,Outpatient,,,449,224.5,,120.6,26.86,,,percent of total billed charges,26.86% of total billed charges,336.75,75,,,percent of total billed charges,75% of total billed charges ,336.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,336.75,75,,,percent of total billed charges,75% of total billed charges ,336.75,75,,,percent of total billed charges,75% of total billed charges ,359.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,226.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,336.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,120.6,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,120.6,359.2,
ADJACENT TISSUE TRANSFER OR REARRANGEMEN,2800006,CDM,521,RC,14000,HCPCS,Outpatient,,,1556.5,778.25,,418.08,26.86,,,percent of total billed charges,26.86% of total billed charges,1167.38,75,,,percent of total billed charges,75% of total billed charges ,1167.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1167.38,75,,,percent of total billed charges,75% of total billed charges ,1167.38,75,,,percent of total billed charges,75% of total billed charges ,1245.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,784.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,1167.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,418.08,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1245.2,
ESCHAROTOMY INITAL INCISION,2800007,CDM,521,RC,16035,HCPCS,Outpatient,,,524.5,262.25,,140.88,26.86,,,percent of total billed charges,26.86% of total billed charges,393.38,75,,,percent of total billed charges,75% of total billed charges ,393.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,393.38,75,,,percent of total billed charges,75% of total billed charges ,393.38,75,,,percent of total billed charges,75% of total billed charges ,419.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,264.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,393.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,140.88,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,140.88,419.6,
DRESSINGS AND OR DEBRIEDEMENT OR PARTIAL,2800008,CDM,521,RC,16020,HCPCS,Outpatient,,,204,102,,54.79,26.86,,,percent of total billed charges,26.86% of total billed charges,153,75,,,percent of total billed charges,75% of total billed charges ,153,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,153,75,,,percent of total billed charges,75% of total billed charges ,153,75,,,percent of total billed charges,75% of total billed charges ,163.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,102.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,153,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,54.79,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,54.79,241.16,
EXCISION TUMOR SOFT TISSUE OF SHOULDER A,2800009,CDM,521,RC,23071,HCPCS,Outpatient,,,1074.5,537.25,,288.61,26.86,,,percent of total billed charges,26.86% of total billed charges,805.88,75,,,percent of total billed charges,75% of total billed charges ,805.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,805.88,75,,,percent of total billed charges,75% of total billed charges ,805.88,75,,,percent of total billed charges,75% of total billed charges ,859.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,541.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,805.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,288.61,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,859.6,
EXCISION OF SKIN AND SUBCUTANEOUS TISSUE,2800010,CDM,521,RC,11470,HCPCS,Outpatient,,,720,360,,193.39,26.86,,,percent of total billed charges,26.86% of total billed charges,540,75,,,percent of total billed charges,75% of total billed charges ,540,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,540,75,,,percent of total billed charges,75% of total billed charges ,540,75,,,percent of total billed charges,75% of total billed charges ,576,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,362.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,540,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,193.39,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,576,
ADJACENT TISSUE TRANSFER OR REARRANGEMEN,2800011,CDM,521,RC,14000,HCPCS,Outpatient,,,1284.5,642.25,,345.02,26.86,,,percent of total billed charges,26.86% of total billed charges,963.38,75,,,percent of total billed charges,75% of total billed charges ,963.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,963.38,75,,,percent of total billed charges,75% of total billed charges ,963.38,75,,,percent of total billed charges,75% of total billed charges ,1027.6,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,647.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,963.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,345.02,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1027.6,
BIOPSY SOFT TISSUE OF THIGH OR KNEE ARE,2800012,CDM,521,RC,27323,HCPCS,Outpatient,,,456.5,228.25,,122.62,26.86,,,percent of total billed charges,26.86% of total billed charges,342.38,75,,,percent of total billed charges,75% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,342.38,75,,,percent of total billed charges,75% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,365.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,230.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,122.62,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,122.62,365.2,
INCESION AND DRAINAGE SHOULDER AREA DEEP,2800013,CDM,521,RC,23030,HCPCS,Outpatient,,,917.5,458.75,,246.44,26.86,,,percent of total billed charges,26.86% of total billed charges,688.13,75,,,percent of total billed charges,75% of total billed charges ,688.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,688.13,75,,,percent of total billed charges,75% of total billed charges ,688.13,75,,,percent of total billed charges,75% of total billed charges ,734,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,462.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,688.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,246.44,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,734,
EXCISION TUMOR SOFT TISSUE OF FACE SCALP,2800014,CDM,521,RC,21014,HCPCS,Outpatient,,,1345,672.5,,361.27,26.86,,,percent of total billed charges,26.86% of total billed charges,1008.75,75,,,percent of total billed charges,75% of total billed charges ,1008.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1008.75,75,,,percent of total billed charges,75% of total billed charges ,1008.75,75,,,percent of total billed charges,75% of total billed charges ,1076,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,677.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,1008.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,361.27,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1076,
BIOPSY OR EXCISION OF LYMPH NODE OPEN,2800015,CDM,521,RC,38500,HCPCS,Outpatient,,,655,327.5,,175.93,26.86,,,percent of total billed charges,26.86% of total billed charges,491.25,75,,,percent of total billed charges,75% of total billed charges ,491.25,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,491.25,75,,,percent of total billed charges,75% of total billed charges ,491.25,75,,,percent of total billed charges,75% of total billed charges ,524,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,330.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,491.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,175.93,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,175.93,524,
OVARIAN CYSTECTOMY UNILATERAL OR BILATER,2800016,CDM,521,RC,58925,HCPCS,Outpatient,,,1958,979,,525.92,26.86,,,percent of total billed charges,26.86% of total billed charges,1468.5,75,,,percent of total billed charges,75% of total billed charges ,1468.5,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,1468.5,75,,,percent of total billed charges,75% of total billed charges ,1468.5,75,,,percent of total billed charges,75% of total billed charges ,1566.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,986.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,1468.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,525.92,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,185.51,1566.4,
EXPL PENETRATED WOUND,2900029,CDM,450,RC,20103,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
BB FFP THAW,4110004,CDM,390,RC,86927,HCPCS,Outpatient,,,284.5,142.25,,76.42,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,76.42,26.86,,,percent of total billed charges,26.86% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,227.6,
IGD,4110005,CDM,301,RC,82784,HCPCS,Outpatient,,,166,83,,11.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,11.69,132.8,
TETANUS ANTIBODY IGG,4110006,CDM,300,RC,86317,HCPCS,Outpatient,,,43.5,21.75,,15.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,34.8,80,,,percent of total billed charges,80% of total billed charges ,10.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.44,24,,,percent of total billed charges,24% of total billed charges ,13.57,31.2,,,percent of total billed charges,31.2% of total billed charges,34.8,80,,,percent of total billed charges,80% of total billed charges,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,34.8,
ALT,4110009,CDM,300,RC,84460,HCPCS,Outpatient,,,101,50.5,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,6.35,80.8,
ALBUMIN,4110010,CDM,301,RC,82040,HCPCS,Outpatient,,,101,50.5,,3.62,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.62,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,3.62,80.8,
BB ANTIBODY ID SHEPEARD,4110011,CDM,300,RC,86870,HCPCS,Outpatient,,,424.5,212.25,,6.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,101.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,339.6,80,,,percent of total billed charges,80% of total billed charges ,102.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,213.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,103.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,101.88,24,,,percent of total billed charges,24% of total billed charges ,132.44,31.2,,,percent of total billed charges,31.2% of total billed charges,339.6,80,,,percent of total billed charges,80% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,6.12,339.6,
PHENOBARBITAL,4110015,CDM,301,RC,80184,HCPCS,Outpatient,,,10.5,5.25,,14.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.4,80,,,percent of total billed charges,80% of total billed charges ,2.55,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,2.52,24,,,percent of total billed charges,24% of total billed charges ,3.28,31.2,,,percent of total billed charges,31.2% of total billed charges,8.4,80,,,percent of total billed charges,80% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,14.41,
HEMOGLOBIN A1C,4110016,CDM,300,RC,83036,HCPCS,Outpatient,,,144,72,,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,115.2,80,,,percent of total billed charges,80% of total billed charges ,34.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,35.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.56,24,,,percent of total billed charges,24% of total billed charges ,44.93,31.2,,,percent of total billed charges,31.2% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,12.2,115.2,
HEP B SURFACE AB QUALITATIVE,4110017,CDM,300,RC,86706,HCPCS,Outpatient,,,356.5,178.25,,13.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,13.51,285.2,
CORTISOL,4110020,CDM,301,RC,82533,HCPCS,Outpatient,,,144,72,,20.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,115.2,80,,,percent of total billed charges,80% of total billed charges ,34.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,35.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.56,24,,,percent of total billed charges,24% of total billed charges ,44.93,31.2,,,percent of total billed charges,31.2% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,20.5,115.2,
ALP,4110021,CDM,300,RC,84075,HCPCS,Outpatient,,,72,36,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,6.35,57.6,
PINWORM PREP,4110023,CDM,300,RC,87172,HCPCS,Outpatient,,,59.5,29.75,,5.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,5.36,47.6,
VALPROIC ACID,4110025,CDM,301,RC,80164,HCPCS,Outpatient,,,199,99.5,,14.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,14.27,159.2,
ELECTROLYTES,4110029,CDM,301,RC,80051,HCPCS,Outpatient,,,166,83,,8.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,8.82,132.8,
Chromatin Nucleosomal Antibody,4110030,CDM,300,RC,86235,HCPCS,Outpatient,,,297.5,148.75,,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,238,80,,,percent of total billed charges,80% of total billed charges ,72.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,149.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,72.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,24,,,percent of total billed charges,24% of total billed charges ,92.82,31.2,,,percent of total billed charges,31.2% of total billed charges,238,80,,,percent of total billed charges,80% of total billed charges,71.4,24,,,percent of total billed charges,24% of total billed charges ,71.4,24,,,percent of total billed charges,24% of total billed charges ,22.55,238,
CKMB,4110036,CDM,301,RC,82553,HCPCS,Outpatient,,,226.5,113.25,,14.52,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,181.2,80,,,percent of total billed charges,80% of total billed charges ,54.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,114.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,169.88,75,,,percent of total billed charges,75% of total billed charges ,55.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.52,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.36,24,,,percent of total billed charges,24% of total billed charges ,70.67,31.2,,,percent of total billed charges,31.2% of total billed charges,181.2,80,,,percent of total billed charges,80% of total billed charges,54.36,24,,,percent of total billed charges,24% of total billed charges ,54.36,24,,,percent of total billed charges,24% of total billed charges ,14.52,181.2,
BB ANTIGEN SCREEN SHEPEARD,4110039,CDM,300,RC,86902,HCPCS,Outpatient,,,272,136,,4.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,65.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,4.3,217.6,
HDL CHOLESTEROL,4110041,CDM,300,RC,83718,HCPCS,Outpatient,,,96,48,,10.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,10.3,76.8,
PROTIME,4111000,CDM,300,RC,85610,HCPCS,Outpatient,,,86.5,43.25,,4.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,64.88,75,,,percent of total billed charges,75% of total billed charges ,64.88,75,,,percent of total billed charges,75% of total billed charges ,20.76,24,,,percent of total billed charges,24% of total billed charges ,64.88,75,,,percent of total billed charges,75% of total billed charges ,64.88,75,,,percent of total billed charges,75% of total billed charges ,69.2,80,,,percent of total billed charges,80% of total billed charges ,20.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,43.6,50.4,,,percent of total billed charges,50.4% of total billed charges ,64.88,75,,,percent of total billed charges,75% of total billed charges ,21.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.76,24,,,percent of total billed charges,24% of total billed charges ,26.99,31.2,,,percent of total billed charges,31.2% of total billed charges,69.2,80,,,percent of total billed charges,80% of total billed charges,20.76,24,,,percent of total billed charges,24% of total billed charges ,20.76,24,,,percent of total billed charges,24% of total billed charges ,4.94,69.2,
APTT,4111001,CDM,300,RC,85730,HCPCS,Outpatient,,,101,50.5,,7.54,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.54,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,7.54,80.8,
PLATELET COUNT,4111002,CDM,300,RC,85049,HCPCS,Outpatient,,,59.5,29.75,,5.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,5.63,47.6,
RETIC COUNT,4111003,CDM,300,RC,85045,HCPCS,Outpatient,,,71,35.5,,5.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.8,80,,,percent of total billed charges,80% of total billed charges ,17.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.04,24,,,percent of total billed charges,24% of total billed charges ,22.15,31.2,,,percent of total billed charges,31.2% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,17.04,24,,,percent of total billed charges,24% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,5.03,56.8,
ESR,4111004,CDM,300,RC,85651,HCPCS,Outpatient,,,71,35.5,,4.46,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,53.25,75,,,percent of total billed charges,75% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,56.8,80,,,percent of total billed charges,80% of total billed charges ,17.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.46,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.04,24,,,percent of total billed charges,24% of total billed charges ,22.15,31.2,,,percent of total billed charges,31.2% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,17.04,24,,,percent of total billed charges,24% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,4.46,56.8,
URINE EO COUNT,4111005,CDM,300,RC,85999,HCPCS,Outpatient,,,71,35.5,,19.07,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.8,80,,,percent of total billed charges,80% of total billed charges ,17.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.07,26.86,,,percent of total billed charges,26.86% of total billed charges,17.04,24,,,percent of total billed charges,24% of total billed charges ,22.15,31.2,,,percent of total billed charges,31.2% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,17.04,24,,,percent of total billed charges,24% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,17.04,56.8,
SICKLE CELL SCREEN,4111007,CDM,300,RC,85660,HCPCS,Outpatient,,,83.5,41.75,,6.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,6.94,66.8,
BLEEDING TIME,4111009,CDM,300,RC,85002,HCPCS,Outpatient,,,83.5,41.75,,5.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,5.66,66.8,
CBC W/DIFF,4111011,CDM,300,RC,85025,HCPCS,Outpatient,,,144,72,,9.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,115.2,80,,,percent of total billed charges,80% of total billed charges ,34.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,35.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.56,24,,,percent of total billed charges,24% of total billed charges ,44.93,31.2,,,percent of total billed charges,31.2% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,9.77,115.2,
WBC COUNT,4111012,CDM,300,RC,85048,HCPCS,Outpatient,,,72,36,,3.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,3.2,57.6,
HEMOGLOBIN,4111015,CDM,300,RC,85018,HCPCS,Outpatient,,,71,35.5,,2.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,53.25,75,,,percent of total billed charges,75% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,56.8,80,,,percent of total billed charges,80% of total billed charges ,17.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.04,24,,,percent of total billed charges,24% of total billed charges ,22.15,31.2,,,percent of total billed charges,31.2% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,17.04,24,,,percent of total billed charges,24% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,2.98,56.8,
HEMATOCRIT,4111016,CDM,300,RC,85014,HCPCS,Outpatient,,,71,35.5,,2.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,53.25,75,,,percent of total billed charges,75% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,56.8,80,,,percent of total billed charges,80% of total billed charges ,17.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.04,24,,,percent of total billed charges,24% of total billed charges ,22.15,31.2,,,percent of total billed charges,31.2% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,17.04,24,,,percent of total billed charges,24% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,2.98,56.8,
VENI PUNCTURE,4111020,CDM,300,RC,36415,HCPCS,Outpatient,,,30,15,,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,24,80,,,percent of total billed charges,80% of total billed charges ,7.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,,,percent of total billed charges,31.2% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,
GASTRIN,4111023,CDM,300,RC,82941,HCPCS,Outpatient,,,297.5,148.75,,22.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,238,80,,,percent of total billed charges,80% of total billed charges ,72.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,149.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,72.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,24,,,percent of total billed charges,24% of total billed charges ,92.82,31.2,,,percent of total billed charges,31.2% of total billed charges,238,80,,,percent of total billed charges,80% of total billed charges,71.4,24,,,percent of total billed charges,24% of total billed charges ,71.4,24,,,percent of total billed charges,24% of total billed charges ,22.18,238,
C DIFF,4111024,CDM,300,RC,87324,HCPCS,Outpatient,,,214,107,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,171.2,80,,,percent of total billed charges,80% of total billed charges ,51.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,52.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.36,24,,,percent of total billed charges,24% of total billed charges ,66.77,31.2,,,percent of total billed charges,31.2% of total billed charges,171.2,80,,,percent of total billed charges,80% of total billed charges,51.36,24,,,percent of total billed charges,24% of total billed charges ,51.36,24,,,percent of total billed charges,24% of total billed charges ,15.08,171.2,
PROLACTIN,4111026,CDM,300,RC,84146,HCPCS,Outpatient,,,226.5,113.25,,24.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,181.2,80,,,percent of total billed charges,80% of total billed charges ,54.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,114.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,169.88,75,,,percent of total billed charges,75% of total billed charges ,55.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.36,24,,,percent of total billed charges,24% of total billed charges ,70.67,31.2,,,percent of total billed charges,31.2% of total billed charges,181.2,80,,,percent of total billed charges,80% of total billed charges,54.36,24,,,percent of total billed charges,24% of total billed charges ,54.36,24,,,percent of total billed charges,24% of total billed charges ,24.37,181.2,
NASAL EO COUNT,4111027,CDM,300,RC,89190,HCPCS,Outpatient,,,59.5,29.75,,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,5.98,47.6,
VANCOMYCIN TROUGH,4111028,CDM,301,RC,80202,HCPCS,Outpatient,,,199,99.5,,14.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,14.27,159.2,
EBV NUCLEAR AG IGG,4111029,CDM,300,RC,86664,HCPCS,Outpatient,,,356.5,178.25,,19.24,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.24,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,19.24,285.2,
CA 125,4111030,CDM,300,RC,86304,HCPCS,Outpatient,,,357.5,178.75,,26.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,268.13,75,,,percent of total billed charges,75% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,85.8,24,,,percent of total billed charges,24% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,286,80,,,percent of total billed charges,80% of total billed charges ,86.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,180.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,87.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.8,24,,,percent of total billed charges,24% of total billed charges ,111.54,31.2,,,percent of total billed charges,31.2% of total billed charges,286,80,,,percent of total billed charges,80% of total billed charges,85.8,24,,,percent of total billed charges,24% of total billed charges ,85.8,24,,,percent of total billed charges,24% of total billed charges ,26.16,286,
PROGESTERONE,4111031,CDM,300,RC,84144,HCPCS,Outpatient,,,170,85,,25.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,136,80,,,percent of total billed charges,80% of total billed charges ,41.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,85.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,41.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,24,,,percent of total billed charges,24% of total billed charges ,53.04,31.2,,,percent of total billed charges,31.2% of total billed charges,136,80,,,percent of total billed charges,80% of total billed charges,40.8,24,,,percent of total billed charges,24% of total billed charges ,40.8,24,,,percent of total billed charges,24% of total billed charges ,25.61,136,
LYME TITER,4111033,CDM,300,RC,86618,HCPCS,Outpatient,,,284.5,142.25,,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,21.42,227.6,
THYROID BINDING GLOBULIN,4111039,CDM,300,RC,84442,HCPCS,Outpatient,,,166,83,,14.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,14.63,132.8,
FECAL FAT,4111040,CDM,301,RC,82705,HCPCS,Outpatient,,,284.5,142.25,,6.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,6.4,227.6,
COLD AGGLUTININ TITER,4111041,CDM,300,RC,86157,HCPCS,Outpatient,,,119.5,59.75,,10.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,10.14,95.6,
INDIA INK PREP,4111042,CDM,300,RC,87210,HCPCS,Outpatient,,,59.5,29.75,,5.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,5.36,47.6,
HAPTOGLOBIN,4111043,CDM,300,RC,83010,HCPCS,Outpatient,,,178,89,,4.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,4.69,142.4,
PORPHYRINS 24 HR URINE,4111045,CDM,300,RC,84120,HCPCS,Outpatient,,,237,118.5,,18.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,18.5,189.6,
HLA B27,4111049,CDM,300,RC,86812,HCPCS,Outpatient,,,297.5,148.75,,32.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,238,80,,,percent of total billed charges,80% of total billed charges ,72.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,149.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,72.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,24,,,percent of total billed charges,24% of total billed charges ,92.82,31.2,,,percent of total billed charges,31.2% of total billed charges,238,80,,,percent of total billed charges,80% of total billed charges,71.4,24,,,percent of total billed charges,24% of total billed charges ,71.4,24,,,percent of total billed charges,24% of total billed charges ,32.45,238,
LACTIC ACID,4111054,CDM,300,RC,83605,HCPCS,Outpatient,,,141,70.5,,13.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,105.75,75,,,percent of total billed charges,75% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,112.8,80,,,percent of total billed charges,80% of total billed charges ,34.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,71.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,34.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.84,24,,,percent of total billed charges,24% of total billed charges ,43.99,31.2,,,percent of total billed charges,31.2% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,33.84,24,,,percent of total billed charges,24% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,13.43,112.8,
TRANSFERRIN,4111055,CDM,300,RC,84466,HCPCS,Outpatient,,,186.5,93.25,,16.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,44.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,149.2,80,,,percent of total billed charges,80% of total billed charges ,45.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,94,50.4,,,percent of total billed charges,50.4% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,45.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,44.76,24,,,percent of total billed charges,24% of total billed charges ,58.19,31.2,,,percent of total billed charges,31.2% of total billed charges,149.2,80,,,percent of total billed charges,80% of total billed charges,44.76,24,,,percent of total billed charges,24% of total billed charges ,44.76,24,,,percent of total billed charges,24% of total billed charges ,16.06,149.2,
CMV IGG AB,4111056,CDM,300,RC,86644,HCPCS,Outpatient,,,155.5,77.75,,14.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,37.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,124.4,80,,,percent of total billed charges,80% of total billed charges ,37.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,78.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,116.63,75,,,percent of total billed charges,75% of total billed charges ,38.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,37.32,24,,,percent of total billed charges,24% of total billed charges ,48.52,31.2,,,percent of total billed charges,31.2% of total billed charges,124.4,80,,,percent of total billed charges,80% of total billed charges,37.32,24,,,percent of total billed charges,24% of total billed charges ,37.32,24,,,percent of total billed charges,24% of total billed charges ,14.63,124.4,
LIDOCAINE,4111058,CDM,301,RC,80176,HCPCS,Outpatient,,,178,89,,18.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,18.47,142.4,
IGE,4111062,CDM,301,RC,82785,HCPCS,Outpatient,,,166,83,,20.71,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.71,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,20.71,132.8,
VARICELLA ZOSTER IGG,4111063,CDM,300,RC,86787,HCPCS,Outpatient,,,166,83,,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,16.2,132.8,
CRP (CARDIAC MARKER),4111064,CDM,300,RC,86141,HCPCS,Outpatient,,,114.5,57.25,,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,16.28,91.6,
PORPHOBILINOGEN,4111071,CDM,300,RC,84106,HCPCS,Outpatient,,,178,89,,5.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,5.39,142.4,
HCV ANTIBODY,4111073,CDM,300,RC,86803,HCPCS,Outpatient,,,255.5,127.75,,10,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,191.63,75,,,percent of total billed charges,75% of total billed charges ,191.63,75,,,percent of total billed charges,75% of total billed charges ,61.32,24,,,percent of total billed charges,24% of total billed charges ,191.63,75,,,percent of total billed charges,75% of total billed charges ,191.63,75,,,percent of total billed charges,75% of total billed charges ,204.4,80,,,percent of total billed charges,80% of total billed charges ,61.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,128.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,191.63,75,,,percent of total billed charges,75% of total billed charges ,62.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,10,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.32,24,,,percent of total billed charges,24% of total billed charges ,79.72,31.2,,,percent of total billed charges,31.2% of total billed charges,204.4,80,,,percent of total billed charges,80% of total billed charges,61.32,24,,,percent of total billed charges,24% of total billed charges ,61.32,24,,,percent of total billed charges,24% of total billed charges ,10,204.4,
FIBRINOGEN,4111075,CDM,300,RC,85384,HCPCS,Outpatient,,,108,54,,10.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,10.68,86.4,
FIBRINOGEN DEGRADATION PRODUCTS,4111076,CDM,300,RC,85362,HCPCS,Outpatient,,,144,72,,8.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,115.2,80,,,percent of total billed charges,80% of total billed charges ,34.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,35.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.56,24,,,percent of total billed charges,24% of total billed charges ,44.93,31.2,,,percent of total billed charges,31.2% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,8.66,115.2,
"ESTRADIOL, TOTAL",4111077,CDM,301,RC,82670,HCPCS,Outpatient,,,188.5,94.25,,35.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.8,80,,,percent of total billed charges,80% of total billed charges ,45.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,95,50.4,,,percent of total billed charges,50.4% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,46.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.24,24,,,percent of total billed charges,24% of total billed charges ,58.81,31.2,,,percent of total billed charges,31.2% of total billed charges,150.8,80,,,percent of total billed charges,80% of total billed charges,45.24,24,,,percent of total billed charges,24% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,35.14,150.8,
IGA,4111079,CDM,301,RC,82784,HCPCS,Outpatient,,,199,99.5,,11.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,11.69,159.2,
IGG,4111080,CDM,301,RC,82784,HCPCS,Outpatient,,,199,99.5,,11.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,11.69,159.2,
IGM,4111081,CDM,301,RC,82784,HCPCS,Outpatient,,,199,99.5,,11.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,11.69,159.2,
"PROTEIN ELECTROPH. W/ IFE REFLEX, SERUM",4111083,CDM,300,RC,84155,HCPCS,Outpatient,,,342,171,,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,256.5,75,,,percent of total billed charges,75% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,273.6,80,,,percent of total billed charges,80% of total billed charges ,82.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,172.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,83.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,82.08,24,,,percent of total billed charges,24% of total billed charges ,106.7,31.2,,,percent of total billed charges,31.2% of total billed charges,273.6,80,,,percent of total billed charges,80% of total billed charges,82.08,24,,,percent of total billed charges,24% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,4.61,273.6,
CA 15-3,4111084,CDM,300,RC,86300,HCPCS,Outpatient,,,188.5,94.25,,26.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,141.38,75,,,percent of total billed charges,75% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,150.8,80,,,percent of total billed charges,80% of total billed charges ,45.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,95,50.4,,,percent of total billed charges,50.4% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,46.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.24,24,,,percent of total billed charges,24% of total billed charges ,58.81,31.2,,,percent of total billed charges,31.2% of total billed charges,150.8,80,,,percent of total billed charges,80% of total billed charges,45.24,24,,,percent of total billed charges,24% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,26.16,150.8,
METANEPHRINES PLASMA,4111085,CDM,300,RC,83835,HCPCS,Outpatient,,,237,118.5,,21.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,21.3,189.6,
NOREPINEPHRINE,4111086,CDM,301,RC,82384,HCPCS,Outpatient,,,356.5,178.25,,31.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,31.75,285.2,
.GIARDIA AG STOOL,4111087,CDM,300,RC,87329,HCPCS,Outpatient,,,199,99.5,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,15.08,159.2,
DHEA S,4111088,CDM,301,RC,82627,HCPCS,Outpatient,,,345,172.5,,27.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,82.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,276,80,,,percent of total billed charges,80% of total billed charges ,83.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,173.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,258.75,75,,,percent of total billed charges,75% of total billed charges ,84.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,82.8,24,,,percent of total billed charges,24% of total billed charges ,107.64,31.2,,,percent of total billed charges,31.2% of total billed charges,276,80,,,percent of total billed charges,80% of total billed charges,82.8,24,,,percent of total billed charges,24% of total billed charges ,82.8,24,,,percent of total billed charges,24% of total billed charges ,27.96,276,
ROTAVIRUS,4111090,CDM,300,RC,87425,HCPCS,Outpatient,,,166,83,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,15.08,132.8,
G6PD,4111091,CDM,300,RC,82955,HCPCS,Outpatient,,,108,54,,9.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,9.82,86.4,
CD4 CD8,4111092,CDM,300,RC,86360,HCPCS,Outpatient,,,783,391.5,,59.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,587.25,75,,,percent of total billed charges,75% of total billed charges ,587.25,75,,,percent of total billed charges,75% of total billed charges ,187.92,24,,,percent of total billed charges,24% of total billed charges ,587.25,75,,,percent of total billed charges,75% of total billed charges ,587.25,75,,,percent of total billed charges,75% of total billed charges ,626.4,80,,,percent of total billed charges,80% of total billed charges ,189.8,24.24,,,percent of total billed charges,24.24% of total billed charges ,394.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,587.25,75,,,percent of total billed charges,75% of total billed charges ,191.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,187.92,24,,,percent of total billed charges,24% of total billed charges ,244.3,31.2,,,percent of total billed charges,31.2% of total billed charges,626.4,80,,,percent of total billed charges,80% of total billed charges,187.92,24,,,percent of total billed charges,24% of total billed charges ,187.92,24,,,percent of total billed charges,24% of total billed charges ,59.09,626.4,
"ALPHA 1 ANTITRYPSIN, QUANT",4111095,CDM,301,RC,82103,HCPCS,Outpatient,,,166,83,,16.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,16.89,132.8,
VITAMIN D 25 OH,4111096,CDM,301,RC,82306,HCPCS,Outpatient,,,357.5,178.75,,37.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,286,80,,,percent of total billed charges,80% of total billed charges ,86.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,180.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,87.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.8,24,,,percent of total billed charges,24% of total billed charges ,111.54,31.2,,,percent of total billed charges,31.2% of total billed charges,286,80,,,percent of total billed charges,80% of total billed charges,85.8,24,,,percent of total billed charges,24% of total billed charges ,85.8,24,,,percent of total billed charges,24% of total billed charges ,37.22,286,
MYCOPLASMA PNEUMONIA IGM,4111097,CDM,300,RC,86738,HCPCS,Outpatient,,,178,89,,16.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,16.66,142.4,
NUCLEOTIDASE 5',4111098,CDM,300,RC,83915,HCPCS,Outpatient,,,119.5,59.75,,14.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,14.02,95.6,
"CYCLOSPORINE, TROUGH",4111101,CDM,301,RC,80158,HCPCS,Outpatient,,,203,101.5,,7.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,162.4,80,,,percent of total billed charges,80% of total billed charges ,49.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,102.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,152.25,75,,,percent of total billed charges,75% of total billed charges ,49.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,48.72,24,,,percent of total billed charges,24% of total billed charges ,63.34,31.2,,,percent of total billed charges,31.2% of total billed charges,162.4,80,,,percent of total billed charges,80% of total billed charges,48.72,24,,,percent of total billed charges,24% of total billed charges ,48.72,24,,,percent of total billed charges,24% of total billed charges ,7.5,162.4,
ACE,4111102,CDM,301,RC,82164,HCPCS,Outpatient,,,166,83,,18.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,18.35,132.8,
LEUKOCYTE ALK PHOS,4111104,CDM,300,RC,85540,HCPCS,Outpatient,,,178,89,,7.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,7.6,142.4,
C PEPTIDE,4111105,CDM,300,RC,84681,HCPCS,Outpatient,,,320.5,160.25,,19.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,256.4,80,,,percent of total billed charges,80% of total billed charges ,77.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,161.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,240.38,75,,,percent of total billed charges,75% of total billed charges ,78.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,76.92,24,,,percent of total billed charges,24% of total billed charges ,100,31.2,,,percent of total billed charges,31.2% of total billed charges,256.4,80,,,percent of total billed charges,80% of total billed charges,76.92,24,,,percent of total billed charges,24% of total billed charges ,76.92,24,,,percent of total billed charges,24% of total billed charges ,19.98,256.4,
URINE 24HR 17 KETOSTERIODS,4111108,CDM,300,RC,83586,HCPCS,Outpatient,,,166,83,,15.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,15.8,132.8,
WET PREP,4111111,CDM,300,RC,87210,HCPCS,Outpatient,,,71,35.5,,5.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,53.25,75,,,percent of total billed charges,75% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,56.8,80,,,percent of total billed charges,80% of total billed charges ,17.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.04,24,,,percent of total billed charges,24% of total billed charges ,22.15,31.2,,,percent of total billed charges,31.2% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,17.04,24,,,percent of total billed charges,24% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,5.36,56.8,
CH 50 TOTAL COMPLEMENT,4111119,CDM,300,RC,86162,HCPCS,Outpatient,,,188.5,94.25,,25.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.8,80,,,percent of total billed charges,80% of total billed charges ,45.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,95,50.4,,,percent of total billed charges,50.4% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,46.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.24,24,,,percent of total billed charges,24% of total billed charges ,58.81,31.2,,,percent of total billed charges,31.2% of total billed charges,150.8,80,,,percent of total billed charges,80% of total billed charges,45.24,24,,,percent of total billed charges,24% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,25.55,150.8,
THYROID STIMULATING IMMUNOGLOBULINS,4111122,CDM,300,RC,84445,HCPCS,Outpatient,,,652,326,,10.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,156.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,521.6,80,,,percent of total billed charges,80% of total billed charges ,158.04,24.24,,,percent of total billed charges,24.24% of total billed charges ,328.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,489,75,,,percent of total billed charges,75% of total billed charges ,159.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,156.48,24,,,percent of total billed charges,24% of total billed charges ,203.42,31.2,,,percent of total billed charges,31.2% of total billed charges,521.6,80,,,percent of total billed charges,80% of total billed charges,156.48,24,,,percent of total billed charges,24% of total billed charges ,156.48,24,,,percent of total billed charges,24% of total billed charges ,10.65,521.6,
THYROGLOBULIN AB,4111124,CDM,300,RC,86800,HCPCS,Outpatient,,,178,89,,20,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,20,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,20,142.4,
BETA 2 MICROGLOBULIN,4111125,CDM,301,RC,82232,HCPCS,Outpatient,,,203,101.5,,20.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,162.4,80,,,percent of total billed charges,80% of total billed charges ,49.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,102.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,152.25,75,,,percent of total billed charges,75% of total billed charges ,49.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,48.72,24,,,percent of total billed charges,24% of total billed charges ,63.34,31.2,,,percent of total billed charges,31.2% of total billed charges,162.4,80,,,percent of total billed charges,80% of total billed charges,48.72,24,,,percent of total billed charges,24% of total billed charges ,48.72,24,,,percent of total billed charges,24% of total billed charges ,20.35,162.4,
SJOGRENS SSA AB,4111128,CDM,300,RC,86235,HCPCS,Outpatient,,,225.5,112.75,,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,180.4,80,,,percent of total billed charges,80% of total billed charges ,54.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,113.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,169.13,75,,,percent of total billed charges,75% of total billed charges ,55.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.12,24,,,percent of total billed charges,24% of total billed charges ,70.36,31.2,,,percent of total billed charges,31.2% of total billed charges,180.4,80,,,percent of total billed charges,80% of total billed charges,54.12,24,,,percent of total billed charges,24% of total billed charges ,54.12,24,,,percent of total billed charges,24% of total billed charges ,22.55,180.4,
MITOCHONDRIAL ANTIBODY,4111132,CDM,300,RC,83516,HCPCS,Outpatient,,,284.5,142.25,,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,13.45,227.6,
ACTIN (SMOOTH MUSCLE AB) IGG,4111133,CDM,300,RC,86015,HCPCS,Outpatient,,,214,107,,9.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,171.2,80,,,percent of total billed charges,80% of total billed charges ,51.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,52.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.36,24,,,percent of total billed charges,24% of total billed charges ,66.77,31.2,,,percent of total billed charges,31.2% of total billed charges,171.2,80,,,percent of total billed charges,80% of total billed charges,51.36,24,,,percent of total billed charges,24% of total billed charges ,51.36,24,,,percent of total billed charges,24% of total billed charges ,9.22,171.2,
HISTAMINE,4111134,CDM,300,RC,83088,HCPCS,Outpatient,,,237,118.5,,37.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,37.13,189.6,
CARDIOLIPIN ANTIBODY IgA,4111135,CDM,300,RC,86147,HCPCS,Outpatient,,,150.5,75.25,,31.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,120.4,80,,,percent of total billed charges,80% of total billed charges ,36.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,75.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,112.88,75,,,percent of total billed charges,75% of total billed charges ,36.84,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,36.12,24,,,percent of total billed charges,24% of total billed charges ,46.96,31.2,,,percent of total billed charges,31.2% of total billed charges,120.4,80,,,percent of total billed charges,80% of total billed charges,36.12,24,,,percent of total billed charges,24% of total billed charges ,36.12,24,,,percent of total billed charges,24% of total billed charges ,31.99,120.4,
CA 19-9,4111136,CDM,300,RC,86301,HCPCS,Outpatient,,,297.5,148.75,,26.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,223.13,75,,,percent of total billed charges,75% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,71.4,24,,,percent of total billed charges,24% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,238,80,,,percent of total billed charges,80% of total billed charges ,72.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,149.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,72.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,24,,,percent of total billed charges,24% of total billed charges ,92.82,31.2,,,percent of total billed charges,31.2% of total billed charges,238,80,,,percent of total billed charges,80% of total billed charges,71.4,24,,,percent of total billed charges,24% of total billed charges ,71.4,24,,,percent of total billed charges,24% of total billed charges ,26.16,238,
URINE CULTURE,4111139,CDM,300,RC,87088,HCPCS,Outpatient,,,114.5,57.25,,10.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,10.18,91.6,
PARVOVIRUS B19 AB,4111141,CDM,300,RC,86747,HCPCS,Outpatient,,,439,219.5,,18.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,329.25,75,,,percent of total billed charges,75% of total billed charges ,329.25,75,,,percent of total billed charges,75% of total billed charges ,105.36,24,,,percent of total billed charges,24% of total billed charges ,329.25,75,,,percent of total billed charges,75% of total billed charges ,329.25,75,,,percent of total billed charges,75% of total billed charges ,351.2,80,,,percent of total billed charges,80% of total billed charges ,106.41,24.24,,,percent of total billed charges,24.24% of total billed charges ,221.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,329.25,75,,,percent of total billed charges,75% of total billed charges ,107.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,105.36,24,,,percent of total billed charges,24% of total billed charges ,136.97,31.2,,,percent of total billed charges,31.2% of total billed charges,351.2,80,,,percent of total billed charges,80% of total billed charges,105.36,24,,,percent of total billed charges,24% of total billed charges ,105.36,24,,,percent of total billed charges,24% of total billed charges ,18.9,351.2,
CHYMOTRYPSIN STOOL,4111144,CDM,300,RC,84311,HCPCS,Outpatient,,,534.5,267.25,,8.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,128.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,427.6,80,,,percent of total billed charges,80% of total billed charges ,129.56,24.24,,,percent of total billed charges,24.24% of total billed charges ,269.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,400.88,75,,,percent of total billed charges,75% of total billed charges ,130.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,128.28,24,,,percent of total billed charges,24% of total billed charges ,166.76,31.2,,,percent of total billed charges,31.2% of total billed charges,427.6,80,,,percent of total billed charges,80% of total billed charges,128.28,24,,,percent of total billed charges,24% of total billed charges ,128.28,24,,,percent of total billed charges,24% of total billed charges ,8.79,427.6,
HISTONE,4111145,CDM,300,RC,83520,HCPCS,Outpatient,,,297.5,148.75,,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,238,80,,,percent of total billed charges,80% of total billed charges ,72.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,149.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,72.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,24,,,percent of total billed charges,24% of total billed charges ,92.82,31.2,,,percent of total billed charges,31.2% of total billed charges,238,80,,,percent of total billed charges,80% of total billed charges,71.4,24,,,percent of total billed charges,24% of total billed charges ,71.4,24,,,percent of total billed charges,24% of total billed charges ,16.28,238,
CITRATE,4111146,CDM,301,RC,82507,HCPCS,Outpatient,,,380,190,,34.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,91.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,304,80,,,percent of total billed charges,80% of total billed charges ,92.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,191.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,285,75,,,percent of total billed charges,75% of total billed charges ,93.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,34.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,91.2,24,,,percent of total billed charges,24% of total billed charges ,118.56,31.2,,,percent of total billed charges,31.2% of total billed charges,304,80,,,percent of total billed charges,80% of total billed charges,91.2,24,,,percent of total billed charges,24% of total billed charges ,91.2,24,,,percent of total billed charges,24% of total billed charges ,34.97,304,
RSV - ANTIGEN,4111149,CDM,300,RC,87420,HCPCS,Outpatient,,,214,107,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,171.2,80,,,percent of total billed charges,80% of total billed charges ,51.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,52.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.36,24,,,percent of total billed charges,24% of total billed charges ,66.77,31.2,,,percent of total billed charges,31.2% of total billed charges,171.2,80,,,percent of total billed charges,80% of total billed charges,51.36,24,,,percent of total billed charges,24% of total billed charges ,51.36,24,,,percent of total billed charges,24% of total billed charges ,15.08,171.2,
CLINDAMYCIN,4111150,CDM,301,RC,80299,HCPCS,Outpatient,,,297.5,148.75,,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,238,80,,,percent of total billed charges,80% of total billed charges ,72.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,149.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,72.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,24,,,percent of total billed charges,24% of total billed charges ,92.82,31.2,,,percent of total billed charges,31.2% of total billed charges,238,80,,,percent of total billed charges,80% of total billed charges,71.4,24,,,percent of total billed charges,24% of total billed charges ,71.4,24,,,percent of total billed charges,24% of total billed charges ,15.14,238,
HALOPERIDOL,4111153,CDM,301,RC,80173,HCPCS,Outpatient,,,297.5,148.75,,18.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,238,80,,,percent of total billed charges,80% of total billed charges ,72.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,149.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,72.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,24,,,percent of total billed charges,24% of total billed charges ,92.82,31.2,,,percent of total billed charges,31.2% of total billed charges,238,80,,,percent of total billed charges,80% of total billed charges,71.4,24,,,percent of total billed charges,24% of total billed charges ,71.4,24,,,percent of total billed charges,24% of total billed charges ,18.31,238,
PTH INTACT W/O CALCIUM,4111157,CDM,300,RC,83970,HCPCS,Outpatient,,,456.5,228.25,,51.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,109.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,365.2,80,,,percent of total billed charges,80% of total billed charges ,110.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,230.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,111.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,51.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,109.56,24,,,percent of total billed charges,24% of total billed charges ,142.43,31.2,,,percent of total billed charges,31.2% of total billed charges,365.2,80,,,percent of total billed charges,80% of total billed charges,109.56,24,,,percent of total billed charges,24% of total billed charges ,109.56,24,,,percent of total billed charges,24% of total billed charges ,51.9,365.2,
CERULOPLASMIN,4111160,CDM,301,RC,82390,HCPCS,Outpatient,,,108,54,,13.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,13.51,86.4,
BB ABO BLOOD TYPE,4111161,CDM,300,RC,86900,HCPCS,Outpatient,,,101,50.5,,3.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,3.75,80.8,
BB RH BLOOD TYPE,4111162,CDM,300,RC,86901,HCPCS,Outpatient,,,101,50.5,,14.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,14.51,80.8,
BB AHG CROSSMATCH CCH,4111163,CDM,300,RC,86922,HCPCS,Outpatient,,,328.5,164.25,,88.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,78.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,262.8,80,,,percent of total billed charges,80% of total billed charges ,79.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,165.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,246.38,75,,,percent of total billed charges,75% of total billed charges ,80.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,88.24,26.86,,,percent of total billed charges,26.86% of total billed charges,78.84,24,,,percent of total billed charges,24% of total billed charges ,102.49,31.2,,,percent of total billed charges,31.2% of total billed charges,262.8,80,,,percent of total billed charges,80% of total billed charges,78.84,24,,,percent of total billed charges,24% of total billed charges ,78.84,24,,,percent of total billed charges,24% of total billed charges ,78.84,262.8,
CALCITONIN,4111166,CDM,301,RC,82308,HCPCS,Outpatient,,,284.5,142.25,,33.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,33.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,33.67,227.6,
H PYLORI AB,4111168,CDM,300,RC,86677,HCPCS,Outpatient,,,284.5,142.25,,18.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,18.25,227.6,
ANTITHROMBIN III ACTIVITY,4111169,CDM,300,RC,85300,HCPCS,Outpatient,,,284.5,142.25,,14.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,14.9,227.6,
HISTOPLASMA AB,4111170,CDM,300,RC,86698,HCPCS,Outpatient,,,119.5,59.75,,15.71,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.71,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,15.71,95.6,
BARTONELLA  HENSELAE IGG,4111172,CDM,300,RC,86611,HCPCS,Outpatient,,,284.5,142.25,,12.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,12.8,227.6,
CLO TEST,4111175,CDM,300,RC,87077,HCPCS,Outpatient,,,101,50.5,,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,10.16,80.8,
MERCURY,4111177,CDM,300,RC,83825,HCPCS,Outpatient,,,114.5,57.25,,20.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,20.45,91.6,
ARSENIC,4111178,CDM,301,RC,82175,HCPCS,Outpatient,,,226.5,113.25,,23.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,181.2,80,,,percent of total billed charges,80% of total billed charges ,54.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,114.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,169.88,75,,,percent of total billed charges,75% of total billed charges ,55.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.36,24,,,percent of total billed charges,24% of total billed charges ,70.67,31.2,,,percent of total billed charges,31.2% of total billed charges,181.2,80,,,percent of total billed charges,80% of total billed charges,54.36,24,,,percent of total billed charges,24% of total billed charges ,54.36,24,,,percent of total billed charges,24% of total billed charges ,23.86,181.2,
JO 1 ANTIBODY,4111179,CDM,300,RC,86235,HCPCS,Outpatient,,,156,78,,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,37.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,124.8,80,,,percent of total billed charges,80% of total billed charges ,37.81,24.24,,,percent of total billed charges,24.24% of total billed charges ,78.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,117,75,,,percent of total billed charges,75% of total billed charges ,38.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,37.44,24,,,percent of total billed charges,24% of total billed charges ,48.67,31.2,,,percent of total billed charges,31.2% of total billed charges,124.8,80,,,percent of total billed charges,80% of total billed charges,37.44,24,,,percent of total billed charges,24% of total billed charges ,37.44,24,,,percent of total billed charges,24% of total billed charges ,22.55,124.8,
RUBEOLA (MEASLES) IgG ANTIBODY,4111185,CDM,300,RC,86765,HCPCS,Outpatient,,,119.5,59.75,,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,16.2,95.6,
COPPER,4111187,CDM,301,RC,82525,HCPCS,Outpatient,,,166,83,,15.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,15.61,132.8,
LEISHMANIA AB,4111188,CDM,300,RC,86717,HCPCS,Outpatient,,,284.5,142.25,,15.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,15.41,227.6,
MALARIA SMEAR,4111190,CDM,300,RC,87207,HCPCS,Outpatient,,,96,48,,7.53,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.53,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,7.53,76.8,
SEROTONIN,4111192,CDM,300,RC,84260,HCPCS,Outpatient,,,345,172.5,,38.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,82.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,276,80,,,percent of total billed charges,80% of total billed charges ,83.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,173.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,258.75,75,,,percent of total billed charges,75% of total billed charges ,84.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,38.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,82.8,24,,,percent of total billed charges,24% of total billed charges ,107.64,31.2,,,percent of total billed charges,31.2% of total billed charges,276,80,,,percent of total billed charges,80% of total billed charges,82.8,24,,,percent of total billed charges,24% of total billed charges ,82.8,24,,,percent of total billed charges,24% of total billed charges ,38.95,276,
IMMUNOFIXATION ELECTROPHORESIS URINE,4111197,CDM,300,RC,84156,HCPCS,Outpatient,,,188.5,94.25,,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.8,80,,,percent of total billed charges,80% of total billed charges ,45.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,95,50.4,,,percent of total billed charges,50.4% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,46.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.24,24,,,percent of total billed charges,24% of total billed charges ,58.81,31.2,,,percent of total billed charges,31.2% of total billed charges,150.8,80,,,percent of total billed charges,80% of total billed charges,45.24,24,,,percent of total billed charges,24% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,4.61,150.8,
HEP B CORE IGM AB,4111198,CDM,300,RC,86705,HCPCS,Outpatient,,,297.5,148.75,,14.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,223.13,75,,,percent of total billed charges,75% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,71.4,24,,,percent of total billed charges,24% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,238,80,,,percent of total billed charges,80% of total billed charges ,72.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,149.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,72.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,24,,,percent of total billed charges,24% of total billed charges ,92.82,31.2,,,percent of total billed charges,31.2% of total billed charges,238,80,,,percent of total billed charges,80% of total billed charges,71.4,24,,,percent of total billed charges,24% of total billed charges ,71.4,24,,,percent of total billed charges,24% of total billed charges ,14.8,238,
ERYTHROPOIETIN,4111200,CDM,301,RC,82668,HCPCS,Outpatient,,,237,118.5,,23.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,23.63,189.6,
LIPID PANEL,4111214,CDM,300,RC,80061,HCPCS,Outpatient,,,255.5,127.75,,16.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,191.63,75,,,percent of total billed charges,75% of total billed charges ,191.63,75,,,percent of total billed charges,75% of total billed charges ,61.32,24,,,percent of total billed charges,24% of total billed charges ,191.63,75,,,percent of total billed charges,75% of total billed charges ,191.63,75,,,percent of total billed charges,75% of total billed charges ,204.4,80,,,percent of total billed charges,80% of total billed charges ,61.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,128.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,191.63,75,,,percent of total billed charges,75% of total billed charges ,62.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.32,24,,,percent of total billed charges,24% of total billed charges ,79.72,31.2,,,percent of total billed charges,31.2% of total billed charges,204.4,80,,,percent of total billed charges,80% of total billed charges,61.32,24,,,percent of total billed charges,24% of total billed charges ,61.32,24,,,percent of total billed charges,24% of total billed charges ,16.85,204.4,
MICRO/CREAT RATIO 24 HR,4111222,CDM,301,RC,82043,HCPCS,Outpatient,,,166,83,,7.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,7.28,132.8,
TOXOPLASMA IGG AB,4111233,CDM,300,RC,86777,HCPCS,Outpatient,,,166,83,,14.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,14.63,132.8,
C1 ESTERASE INHIBITOR QUANT,4111234,CDM,300,RC,86160,HCPCS,Outpatient,,,226.5,113.25,,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,181.2,80,,,percent of total billed charges,80% of total billed charges ,54.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,114.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,169.88,75,,,percent of total billed charges,75% of total billed charges ,55.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.36,24,,,percent of total billed charges,24% of total billed charges ,70.67,31.2,,,percent of total billed charges,31.2% of total billed charges,181.2,80,,,percent of total billed charges,80% of total billed charges,54.36,24,,,percent of total billed charges,24% of total billed charges ,54.36,24,,,percent of total billed charges,24% of total billed charges ,15.1,181.2,
NEURONTIN,4111236,CDM,301,RC,80299,HCPCS,Outpatient,,,166,83,,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,15.14,132.8,
ACETYL REC BIND ANTIBODY,4111238,CDM,300,RC,83519,HCPCS,Outpatient,,,166,83,,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,16.99,132.8,
..TROPONIN I,4111240,CDM,301,RC,84484,HCPCS,Outpatient,,,342,171,,12.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,82.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,273.6,80,,,percent of total billed charges,80% of total billed charges ,82.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,172.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,83.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,82.08,24,,,percent of total billed charges,24% of total billed charges ,106.7,31.2,,,percent of total billed charges,31.2% of total billed charges,273.6,80,,,percent of total billed charges,80% of total billed charges,82.08,24,,,percent of total billed charges,24% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,12.38,273.6,
LIVER/KIDNEY MICROSOMAL AB,4111245,CDM,300,RC,86376,HCPCS,Outpatient,,,284.5,142.25,,18.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,18.3,227.6,
EHRLICHIA ABS,4111247,CDM,300,RC,86256,HCPCS,Outpatient,,,213,106.5,,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,15.16,170.4,
LEPTOSPIRA TITER,4111248,CDM,300,RC,86720,HCPCS,Outpatient,,,108,54,,16.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,81,75,,,percent of total billed charges,75% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,16.59,86.4,
LIPOPROTEIN A,4111250,CDM,300,RC,83695,HCPCS,Outpatient,,,166,83,,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,16.28,132.8,
HOMOCYSTEINE,4111251,CDM,300,RC,83090,HCPCS,Outpatient,,,384,192,,21.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,92.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,307.2,80,,,percent of total billed charges,80% of total billed charges ,93.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,193.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,288,75,,,percent of total billed charges,75% of total billed charges ,94,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,92.16,24,,,percent of total billed charges,24% of total billed charges ,119.81,31.2,,,percent of total billed charges,31.2% of total billed charges,307.2,80,,,percent of total billed charges,80% of total billed charges,92.16,24,,,percent of total billed charges,24% of total billed charges ,92.16,24,,,percent of total billed charges,24% of total billed charges ,21.21,307.2,
CENTROMERE ANTIBODY,4111260,CDM,300,RC,86235,HCPCS,Outpatient,,,213,106.5,,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,22.55,170.4,
SCLERODERMA  (SCL-70) AB,4111261,CDM,300,RC,86235,HCPCS,Outpatient,,,166,83,,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,22.55,132.8,
THYROID PEROXIDASE AB,4111264,CDM,300,RC,86376,HCPCS,Outpatient,,,96,48,,18.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,18.3,76.8,
SJOGRENS SSB AB,4111265,CDM,300,RC,86235,HCPCS,Outpatient,,,96,48,,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,22.55,76.8,
"PROTEIN IMMUNOFIXATION, SERUM",4111267,CDM,300,RC,86334,HCPCS,Outpatient,,,134,67,,28.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,100.5,75,,,percent of total billed charges,75% of total billed charges ,100.5,75,,,percent of total billed charges,75% of total billed charges ,32.16,24,,,percent of total billed charges,24% of total billed charges ,100.5,75,,,percent of total billed charges,75% of total billed charges ,100.5,75,,,percent of total billed charges,75% of total billed charges ,107.2,80,,,percent of total billed charges,80% of total billed charges ,32.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,67.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,100.5,75,,,percent of total billed charges,75% of total billed charges ,32.8,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,32.16,24,,,percent of total billed charges,24% of total billed charges ,41.81,31.2,,,percent of total billed charges,31.2% of total billed charges,107.2,80,,,percent of total billed charges,80% of total billed charges,32.16,24,,,percent of total billed charges,24% of total billed charges ,32.16,24,,,percent of total billed charges,24% of total billed charges ,28.09,107.2,
PROINSULIN,4111268,CDM,300,RC,84206,HCPCS,Outpatient,,,474,237,,22.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,113.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,379.2,80,,,percent of total billed charges,80% of total billed charges ,114.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,238.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,116.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,113.76,24,,,percent of total billed charges,24% of total billed charges ,147.89,31.2,,,percent of total billed charges,31.2% of total billed charges,379.2,80,,,percent of total billed charges,80% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,22.4,379.2,
SMITH ANTIBODY,4111269,CDM,300,RC,86235,HCPCS,Outpatient,,,119.5,59.75,,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,22.55,95.6,
RNP ANTIBODY,4111270,CDM,300,RC,86235,HCPCS,Outpatient,,,119.5,59.75,,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,22.55,95.6,
ANCA SCREEN,4111271,CDM,300,RC,86036,HCPCS,Outpatient,,,166,83,,9.64,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.64,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,9.64,132.8,
FACTOR V ACTIVITY,4111272,CDM,300,RC,85220,HCPCS,Outpatient,,,652,326,,22.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,156.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,521.6,80,,,percent of total billed charges,80% of total billed charges ,158.04,24.24,,,percent of total billed charges,24.24% of total billed charges ,328.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,489,75,,,percent of total billed charges,75% of total billed charges ,159.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,156.48,24,,,percent of total billed charges,24% of total billed charges ,203.42,31.2,,,percent of total billed charges,31.2% of total billed charges,521.6,80,,,percent of total billed charges,80% of total billed charges,156.48,24,,,percent of total billed charges,24% of total billed charges ,156.48,24,,,percent of total billed charges,24% of total billed charges ,22.19,521.6,
HIV 1 RNA VIRAL LOAD,4111273,CDM,300,RC,87536,HCPCS,Outpatient,,,427.5,213.75,,56.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,320.63,75,,,percent of total billed charges,75% of total billed charges ,320.63,75,,,percent of total billed charges,75% of total billed charges ,102.6,24,,,percent of total billed charges,24% of total billed charges ,320.63,75,,,percent of total billed charges,75% of total billed charges ,320.63,75,,,percent of total billed charges,75% of total billed charges ,342,80,,,percent of total billed charges,80% of total billed charges ,103.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,215.46,50.4,,,percent of total billed charges,50.4% of total billed charges ,320.63,75,,,percent of total billed charges,75% of total billed charges ,104.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,56.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,102.6,24,,,percent of total billed charges,24% of total billed charges ,133.38,31.2,,,percent of total billed charges,31.2% of total billed charges,342,80,,,percent of total billed charges,80% of total billed charges,102.6,24,,,percent of total billed charges,24% of total billed charges ,102.6,24,,,percent of total billed charges,24% of total billed charges ,56.5,342,
CO2,4111274,CDM,301,RC,82374,HCPCS,Outpatient,,,59.5,29.75,,6.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,6.15,47.6,
TACROLIMUS,4111275,CDM,301,RC,80197,HCPCS,Outpatient,,,384,192,,17.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,92.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,307.2,80,,,percent of total billed charges,80% of total billed charges ,93.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,193.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,288,75,,,percent of total billed charges,75% of total billed charges ,94,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,92.16,24,,,percent of total billed charges,24% of total billed charges ,119.81,31.2,,,percent of total billed charges,31.2% of total billed charges,307.2,80,,,percent of total billed charges,80% of total billed charges,92.16,24,,,percent of total billed charges,24% of total billed charges ,92.16,24,,,percent of total billed charges,24% of total billed charges ,17.25,307.2,
HEP C RIBAVIRIN,4111277,CDM,300,RC,86804,HCPCS,Outpatient,,,166,83,,19.48,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.48,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,19.48,132.8,
HCV RNA QUANT PCR,4111278,CDM,300,RC,87522,HCPCS,Outpatient,,,497.5,248.75,,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,373.13,75,,,percent of total billed charges,75% of total billed charges ,373.13,75,,,percent of total billed charges,75% of total billed charges ,119.4,24,,,percent of total billed charges,24% of total billed charges ,373.13,75,,,percent of total billed charges,75% of total billed charges ,373.13,75,,,percent of total billed charges,75% of total billed charges ,398,80,,,percent of total billed charges,80% of total billed charges ,120.59,24.24,,,percent of total billed charges,24.24% of total billed charges ,250.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,373.13,75,,,percent of total billed charges,75% of total billed charges ,121.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,119.4,24,,,percent of total billed charges,24% of total billed charges ,155.22,31.2,,,percent of total billed charges,31.2% of total billed charges,398,80,,,percent of total billed charges,80% of total billed charges,119.4,24,,,percent of total billed charges,24% of total billed charges ,119.4,24,,,percent of total billed charges,24% of total billed charges ,53.87,398,
ZINC,4111279,CDM,300,RC,84630,HCPCS,Outpatient,,,96,48,,14.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,14.32,76.8,
METHYLMALONIC ACID,4111282,CDM,300,RC,83921,HCPCS,Outpatient,,,255.5,127.75,,20.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,204.4,80,,,percent of total billed charges,80% of total billed charges ,61.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,128.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,191.63,75,,,percent of total billed charges,75% of total billed charges ,62.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.32,24,,,percent of total billed charges,24% of total billed charges ,79.72,31.2,,,percent of total billed charges,31.2% of total billed charges,204.4,80,,,percent of total billed charges,80% of total billed charges,61.32,24,,,percent of total billed charges,24% of total billed charges ,61.32,24,,,percent of total billed charges,24% of total billed charges ,20.7,204.4,
HIV ANTIGEN & ANTIBODY WITH REFLEX,4111283,CDM,300,RC,87389,HCPCS,Outpatient,,,166,83,,27.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,27.3,132.8,
ENDOMYSIAL IGA AB,4111284,CDM,300,RC,86256,HCPCS,Outpatient,,,199,99.5,,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,15.16,159.2,
HSV 1 IGG,4111285,CDM,300,RC,86695,HCPCS,Outpatient,,,284.5,142.25,,16.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,16.59,227.6,
LYSOZYME,4111287,CDM,300,RC,85549,HCPCS,Outpatient,,,119.5,59.75,,23.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,23.59,95.6,
SOMATOMEDIN C,4111288,CDM,300,RC,84305,HCPCS,Outpatient,,,188.5,94.25,,26.73,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.8,80,,,percent of total billed charges,80% of total billed charges ,45.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,95,50.4,,,percent of total billed charges,50.4% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,46.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.73,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.24,24,,,percent of total billed charges,24% of total billed charges ,58.81,31.2,,,percent of total billed charges,31.2% of total billed charges,150.8,80,,,percent of total billed charges,80% of total billed charges,45.24,24,,,percent of total billed charges,24% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,26.73,150.8,
FACTOR VIII ACTIVITY,4111289,CDM,300,RC,85240,HCPCS,Outpatient,,,427.5,213.75,,22.52,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,102.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,342,80,,,percent of total billed charges,80% of total billed charges ,103.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,215.46,50.4,,,percent of total billed charges,50.4% of total billed charges ,320.63,75,,,percent of total billed charges,75% of total billed charges ,104.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.52,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,102.6,24,,,percent of total billed charges,24% of total billed charges ,133.38,31.2,,,percent of total billed charges,31.2% of total billed charges,342,80,,,percent of total billed charges,80% of total billed charges,102.6,24,,,percent of total billed charges,24% of total billed charges ,102.6,24,,,percent of total billed charges,24% of total billed charges ,22.52,342,
VITAMIN B6,4111290,CDM,300,RC,84207,HCPCS,Outpatient,,,213,106.5,,35.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,35.33,170.4,
THIAMINE,4111291,CDM,300,RC,84425,HCPCS,Outpatient,,,166,83,,26.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,26.7,132.8,
MICRO/CREAT RATIO,4111293,CDM,301,RC,82043,HCPCS,Outpatient,,,114.5,57.25,,7.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,7.28,91.6,
CRYPTOSPORIDIUM AG STOOL,4111299,CDM,300,RC,87328,HCPCS,Outpatient,,,108,54,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,15.08,86.4,
BASIC METABOLIC PANEL,4111304,CDM,301,RC,80048,HCPCS,Outpatient,,,284.5,142.25,,10.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,10.65,227.6,
COMPREHENSIVE METABOLIC PANEL,4111305,CDM,301,RC,80053,HCPCS,Outpatient,,,427.5,213.75,,13.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,320.63,75,,,percent of total billed charges,75% of total billed charges ,320.63,75,,,percent of total billed charges,75% of total billed charges ,102.6,24,,,percent of total billed charges,24% of total billed charges ,320.63,75,,,percent of total billed charges,75% of total billed charges ,320.63,75,,,percent of total billed charges,75% of total billed charges ,342,80,,,percent of total billed charges,80% of total billed charges ,103.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,215.46,50.4,,,percent of total billed charges,50.4% of total billed charges ,320.63,75,,,percent of total billed charges,75% of total billed charges ,104.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,102.6,24,,,percent of total billed charges,24% of total billed charges ,133.38,31.2,,,percent of total billed charges,31.2% of total billed charges,342,80,,,percent of total billed charges,80% of total billed charges,102.6,24,,,percent of total billed charges,24% of total billed charges ,102.6,24,,,percent of total billed charges,24% of total billed charges ,13.29,342,
RENAL PANEL,4111306,CDM,301,RC,80069,HCPCS,Outpatient,,,284.5,142.25,,10.92,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.92,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,10.92,227.6,
ACUTE HEPATITIS PANEL,4111307,CDM,301,RC,80074,HCPCS,Outpatient,,,568.5,284.25,,59.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,136.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,454.8,80,,,percent of total billed charges,80% of total billed charges ,137.8,24.24,,,percent of total billed charges,24.24% of total billed charges ,286.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,426.38,75,,,percent of total billed charges,75% of total billed charges ,139.17,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,136.44,24,,,percent of total billed charges,24% of total billed charges ,177.37,31.2,,,percent of total billed charges,31.2% of total billed charges,454.8,80,,,percent of total billed charges,80% of total billed charges,136.44,24,,,percent of total billed charges,24% of total billed charges ,136.44,24,,,percent of total billed charges,24% of total billed charges ,59.89,454.8,
HEPATITIS A IGM ANTIBODY,4111308,CDM,300,RC,86709,HCPCS,Outpatient,,,166,83,,14.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,14.16,132.8,
T4 FREE,4111309,CDM,300,RC,84439,HCPCS,Outpatient,,,144,72,,11.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,115.2,80,,,percent of total billed charges,80% of total billed charges ,34.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,35.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.56,24,,,percent of total billed charges,24% of total billed charges ,44.93,31.2,,,percent of total billed charges,31.2% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,11.34,115.2,
TRILEPTAL LEVEL,4111310,CDM,301,RC,80183,HCPCS,Outpatient,,,213,106.5,,14.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,14.47,170.4,
BLOOD ALCOHOL,4111311,CDM,301,RC,82077,HCPCS,Outpatient,,,101,50.5,,13.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,13.82,80.8,
URINE 24 HR UREA CLEARANCE,4111313,CDM,300,RC,84545,HCPCS,Outpatient,,,96,48,,8.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,8.31,76.8,
FRUCTOSAMINE,4111317,CDM,300,RC,82985,HCPCS,Outpatient,,,96,48,,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,18.95,76.8,
ECHINOCOCCUS IGG AB,4111318,CDM,300,RC,86682,HCPCS,Outpatient,,,188.5,94.25,,16.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.8,80,,,percent of total billed charges,80% of total billed charges ,45.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,95,50.4,,,percent of total billed charges,50.4% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,46.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.24,24,,,percent of total billed charges,24% of total billed charges ,58.81,31.2,,,percent of total billed charges,31.2% of total billed charges,150.8,80,,,percent of total billed charges,80% of total billed charges,45.24,24,,,percent of total billed charges,24% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,16.35,150.8,
TOPIRAMATE,4111320,CDM,301,RC,80201,HCPCS,Outpatient,,,166,83,,14.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,14.99,132.8,
PSA FREE,4111321,CDM,300,RC,84154,HCPCS,Outpatient,,,214,107,,23.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,171.2,80,,,percent of total billed charges,80% of total billed charges ,51.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,52.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.36,24,,,percent of total billed charges,24% of total billed charges ,66.77,31.2,,,percent of total billed charges,31.2% of total billed charges,171.2,80,,,percent of total billed charges,80% of total billed charges,51.36,24,,,percent of total billed charges,24% of total billed charges ,51.36,24,,,percent of total billed charges,24% of total billed charges ,23.13,171.2,
DIRECT BILIRUBIN,4111322,CDM,301,RC,82248,HCPCS,Outpatient,,,144,72,,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,115.2,80,,,percent of total billed charges,80% of total billed charges ,34.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,35.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.56,24,,,percent of total billed charges,24% of total billed charges ,44.93,31.2,,,percent of total billed charges,31.2% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,6.32,115.2,
TOTAL BILIRUBIN,4111325,CDM,301,RC,82247,HCPCS,Outpatient,,,144,72,,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,115.2,80,,,percent of total billed charges,80% of total billed charges ,34.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,35.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.56,24,,,percent of total billed charges,24% of total billed charges ,44.93,31.2,,,percent of total billed charges,31.2% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,6.32,115.2,
URINE CREATININE,4111326,CDM,301,RC,82570,HCPCS,Outpatient,,,114.5,57.25,,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,6.51,91.6,
BB TRANSFUSE PRBC,4111329,CDM,390,RC,P9016,HCPCS,Outpatient,,,1167,583.5,,313.46,26.86,,,percent of total billed charges,26.86% of total billed charges,875.25,75,,,percent of total billed charges,75% of total billed charges ,875.25,75,,,percent of total billed charges,75% of total billed charges ,280.08,24,,,percent of total billed charges,24% of total billed charges ,875.25,75,,,percent of total billed charges,75% of total billed charges ,875.25,75,,,percent of total billed charges,75% of total billed charges ,933.6,80,,,percent of total billed charges,80% of total billed charges ,282.88,24.24,,,percent of total billed charges,24.24% of total billed charges ,588.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,875.25,75,,,percent of total billed charges,75% of total billed charges ,285.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,313.46,26.86,,,percent of total billed charges,26.86% of total billed charges,280.08,24,,,percent of total billed charges,24% of total billed charges ,364.1,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,280.08,24,,,percent of total billed charges,24% of total billed charges ,280.08,24,,,percent of total billed charges,24% of total billed charges ,280.08,933.6,
BB TRANSFUSE FFP,4111330,CDM,390,RC,P9059,HCPCS,Outpatient,,,474,237,,127.32,26.86,,,percent of total billed charges,26.86% of total billed charges,355.5,75,,,percent of total billed charges,75% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,379.2,80,,,percent of total billed charges,80% of total billed charges ,114.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,238.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,116.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,127.32,26.86,,,percent of total billed charges,26.86% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,147.89,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,379.2,
BB TRANSFUSE PLATELET PHORESIS,4111331,CDM,390,RC,P9035,HCPCS,Outpatient,,,3448.5,1724.25,,926.27,26.86,,,percent of total billed charges,26.86% of total billed charges,2586.38,75,,,percent of total billed charges,75% of total billed charges ,2586.38,75,,,percent of total billed charges,75% of total billed charges ,827.64,24,,,percent of total billed charges,24% of total billed charges ,2586.38,75,,,percent of total billed charges,75% of total billed charges ,2586.38,75,,,percent of total billed charges,75% of total billed charges ,2758.8,80,,,percent of total billed charges,80% of total billed charges ,835.92,24.24,,,percent of total billed charges,24.24% of total billed charges ,1738.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,2586.38,75,,,percent of total billed charges,75% of total billed charges ,844.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,926.27,26.86,,,percent of total billed charges,26.86% of total billed charges,827.64,24,,,percent of total billed charges,24% of total billed charges ,1075.93,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,827.64,24,,,percent of total billed charges,24% of total billed charges ,827.64,24,,,percent of total billed charges,24% of total billed charges ,827.64,2758.8,
TOTAL T3,4111332,CDM,300,RC,84480,HCPCS,Outpatient,,,119.5,59.75,,16.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,16.03,95.6,
HBV DNA QUANT PCR,4111333,CDM,300,RC,87517,HCPCS,Outpatient,,,168,84,,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,126,75,,,percent of total billed charges,75% of total billed charges ,126,75,,,percent of total billed charges,75% of total billed charges ,40.32,24,,,percent of total billed charges,24% of total billed charges ,126,75,,,percent of total billed charges,75% of total billed charges ,126,75,,,percent of total billed charges,75% of total billed charges ,134.4,80,,,percent of total billed charges,80% of total billed charges ,40.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,84.67,50.4,,,percent of total billed charges,50.4% of total billed charges ,126,75,,,percent of total billed charges,75% of total billed charges ,41.13,24.48,,,percent of total billed charges,24.48% of total billed charges ,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.32,24,,,percent of total billed charges,24% of total billed charges ,52.42,31.2,,,percent of total billed charges,31.2% of total billed charges,134.4,80,,,percent of total billed charges,80% of total billed charges,40.32,24,,,percent of total billed charges,24% of total billed charges ,40.32,24,,,percent of total billed charges,24% of total billed charges ,40.32,134.4,
BB TRANSFUSE BLOOD PRODUCT,4111334,CDM,391,RC,36430,HCPCS,Outpatient,,,1128,564,,302.98,26.86,,,percent of total billed charges,26.86% of total billed charges,846,75,,,percent of total billed charges,75% of total billed charges ,846,75,,,percent of total billed charges,75% of total billed charges ,270.72,24,,,percent of total billed charges,24% of total billed charges ,846,75,,,percent of total billed charges,75% of total billed charges ,846,75,,,percent of total billed charges,75% of total billed charges ,902.4,80,,,percent of total billed charges,80% of total billed charges ,273.43,24.24,,,percent of total billed charges,24.24% of total billed charges ,568.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,846,75,,,percent of total billed charges,75% of total billed charges ,276.13,24.48,,,percent of total billed charges,24.48% of total billed charges ,302.98,26.86,,,percent of total billed charges,26.86% of total billed charges,270.72,24,,,percent of total billed charges,24% of total billed charges ,351.94,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,270.72,24,,,percent of total billed charges,24% of total billed charges ,270.72,24,,,percent of total billed charges,24% of total billed charges ,270.72,902.4,
LAMOTRIGINE,4111337,CDM,301,RC,80175,HCPCS,Outpatient,,,166,83,,14.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,14.47,132.8,
HBV SURFACE AG W/ REFLEX,4111342,CDM,300,RC,87340,HCPCS,Outpatient,,,166,83,,12.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,12.99,132.8,
URINE SODIUM,4111346,CDM,300,RC,84300,HCPCS,Outpatient,,,114.5,57.25,,4.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,4.35,91.6,
CLONAZEPAM,4111347,CDM,301,RC,80346,HCPCS,Outpatient,,,119.5,59.75,,23.26,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.26,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,23.26,95.6,
ANTI DNASE B AB,4111351,CDM,300,RC,86215,HCPCS,Outpatient,,,213,106.5,,16.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,16.66,170.4,
URINE 24 HR CYSTINE,4111354,CDM,301,RC,82131,HCPCS,Outpatient,,,119.5,59.75,,21.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,21.21,95.6,
"GLOMERULAR BASEMENT MEMBRANE, IGG",4111355,CDM,300,RC,83520,HCPCS,Outpatient,,,178,89,,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,16.28,142.4,
VIRAL CULTURE,4111357,CDM,300,RC,87252,HCPCS,Outpatient,,,213,106.5,,27.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,27.8,170.4,
WEST NILE VIRUS,4111358,CDM,300,RC,86789,HCPCS,Outpatient,,,772.5,386.25,,14.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,579.38,75,,,percent of total billed charges,75% of total billed charges ,579.38,75,,,percent of total billed charges,75% of total billed charges ,185.4,24,,,percent of total billed charges,24% of total billed charges ,579.38,75,,,percent of total billed charges,75% of total billed charges ,579.38,75,,,percent of total billed charges,75% of total billed charges ,618,80,,,percent of total billed charges,80% of total billed charges ,187.25,24.24,,,percent of total billed charges,24.24% of total billed charges ,389.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,579.38,75,,,percent of total billed charges,75% of total billed charges ,189.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.4,24,,,percent of total billed charges,24% of total billed charges ,241.02,31.2,,,percent of total billed charges,31.2% of total billed charges,618,80,,,percent of total billed charges,80% of total billed charges,185.4,24,,,percent of total billed charges,24% of total billed charges ,185.4,24,,,percent of total billed charges,24% of total billed charges ,14.63,618,
AMIKACIN PEAK,4111360,CDM,300,RC,80150,HCPCS,Outpatient,,,166,83,,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,18.95,132.8,
GENTAMICIN PEAK,4111361,CDM,301,RC,80170,HCPCS,Outpatient,,,166,83,,20.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,20.61,132.8,
URINE OSMOLALITY,4111363,CDM,300,RC,83935,HCPCS,Outpatient,,,199,99.5,,8.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,8.57,159.2,
VANCOMYCIN PEAK,4111364,CDM,301,RC,80202,HCPCS,Outpatient,,,166,83,,14.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,14.27,132.8,
URINE 24 HR SODIUM,4111365,CDM,300,RC,84300,HCPCS,Outpatient,,,119.5,59.75,,4.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,4.35,95.6,
POTASSIUM 24 HOUR URINE,4111366,CDM,300,RC,84133,HCPCS,Outpatient,,,119.5,59.75,,5.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,5.41,95.6,
POTASSIUM URINE,4111367,CDM,300,RC,84133,HCPCS,Outpatient,,,83.5,41.75,,5.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,5.41,66.8,
URINE CHLORIDE,4111368,CDM,301,RC,82436,HCPCS,Outpatient,,,101,50.5,,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,6.32,80.8,
URINE 24 HR CHLORIDE,4111369,CDM,301,RC,82436,HCPCS,Outpatient,,,119.5,59.75,,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,6.32,95.6,
URINE 24 HR CREAT,4111371,CDM,301,RC,82570,HCPCS,Outpatient,,,119.5,59.75,,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,6.51,95.6,
URINE 24 HR PHOSPHORUS,4111372,CDM,300,RC,84105,HCPCS,Outpatient,,,119.5,59.75,,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,6.51,95.6,
URINE UREA,4111373,CDM,300,RC,84540,HCPCS,Outpatient,,,83.5,41.75,,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,5.98,66.8,
URINE 24 HR URIC ACID,4111375,CDM,300,RC,84560,HCPCS,Outpatient,,,119.5,59.75,,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,5.98,95.6,
URINE 24 HR MAGNESIUM,4111377,CDM,300,RC,83735,HCPCS,Outpatient,,,119.5,59.75,,8.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,8.42,95.6,
...STOOL CULTURE - do not use,4111378,CDM,300,RC,87045,HCPCS,Outpatient,,,114.5,57.25,,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,91.6,
GLIADIN AB IGG,4111380,CDM,300,RC,86258,HCPCS,Outpatient,,,255.5,127.75,,9.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,204.4,80,,,percent of total billed charges,80% of total billed charges ,61.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,128.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,191.63,75,,,percent of total billed charges,75% of total billed charges ,62.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.32,24,,,percent of total billed charges,24% of total billed charges ,79.72,31.2,,,percent of total billed charges,31.2% of total billed charges,204.4,80,,,percent of total billed charges,80% of total billed charges,61.32,24,,,percent of total billed charges,24% of total billed charges ,61.32,24,,,percent of total billed charges,24% of total billed charges ,9.22,204.4,
TTG IGA AB,4111381,CDM,300,RC,83516,HCPCS,Outpatient,,,284.5,142.25,,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,13.45,227.6,
RETICULIN IGG AB,4111382,CDM,300,RC,86256,HCPCS,Outpatient,,,213,106.5,,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,15.16,170.4,
URINE CYSTINE,4111384,CDM,301,RC,82131,HCPCS,Outpatient,,,119.5,59.75,,21.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,21.21,95.6,
A1A WITH PHENO,4111385,CDM,301,RC,82104,HCPCS,Outpatient,,,166,83,,18.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,18.18,132.8,
17 OH-PROGESTERONE,4111389,CDM,300,RC,83498,HCPCS,Outpatient,,,237,118.5,,34.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,34.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,34.16,189.6,
GLUCOSE TOLERANCE 2 HR,4112000,CDM,300,RC,82947,HCPCS,Outpatient,,,119.5,59.75,,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,4.93,95.6,
GLUCOSE TOLERANCE 3HR,4112004,CDM,300,RC,82951,HCPCS,Outpatient,,,166,83,,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,16.19,132.8,
GLUCOSE TOLERANCE 4HR,4112005,CDM,300,RC,82951,HCPCS,Outpatient,,,213,106.5,,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,159.75,75,,,percent of total billed charges,75% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,16.19,170.4,
GLUCOSE TOLERANCE - 5 HR,4112006,CDM,300,RC,82951,HCPCS,Outpatient,,,284.5,142.25,,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,16.19,227.6,
CREATININE CLEARANCE,4112008,CDM,301,RC,82575,HCPCS,Outpatient,,,166,83,,11.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,11.88,132.8,
URINE AMYLASE,4112009,CDM,301,RC,82150,HCPCS,Outpatient,,,141,70.5,,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,105.75,75,,,percent of total billed charges,75% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,112.8,80,,,percent of total billed charges,80% of total billed charges ,34.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,71.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,34.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.84,24,,,percent of total billed charges,24% of total billed charges ,43.99,31.2,,,percent of total billed charges,31.2% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,33.84,24,,,percent of total billed charges,24% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,8.15,112.8,
"GLUCOSE, SYNOVIAL FLUID",4112011,CDM,300,RC,82945,HCPCS,Outpatient,,,96,48,,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,4.93,76.8,
CSF PROTEIN,4112012,CDM,300,RC,84157,HCPCS,Outpatient,,,96,48,,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,4.61,76.8,
2 HR PP GLUCOSE,4113000,CDM,300,RC,82950,HCPCS,Outpatient,,,166,83,,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,5.98,132.8,
SODIUM,4113002,CDM,300,RC,84295,HCPCS,Outpatient,,,83.5,41.75,,6.05,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.05,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,6.05,66.8,
POTASSIUM,4113003,CDM,300,RC,84132,HCPCS,Outpatient,,,101,50.5,,5.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,5.78,80.8,
CHLORIDE,4113004,CDM,301,RC,82435,HCPCS,Outpatient,,,83.5,41.75,,5.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,5.78,66.8,
BUN,4113006,CDM,300,RC,84520,HCPCS,Outpatient,,,101,50.5,,4.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,4.96,80.8,
CREATININE,4113007,CDM,301,RC,82565,HCPCS,Outpatient,,,101,50.5,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,6.35,80.8,
CALCIUM,4113008,CDM,301,RC,82310,HCPCS,Outpatient,,,101,50.5,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,6.35,80.8,
URIC ACID,4113009,CDM,300,RC,84550,HCPCS,Outpatient,,,101,50.5,,5.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,5.68,80.8,
PHOSPHORUS,4113010,CDM,300,RC,84100,HCPCS,Outpatient,,,101,50.5,,5.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,5.97,80.8,
AST,4113011,CDM,300,RC,84450,HCPCS,Outpatient,,,101,50.5,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,6.35,80.8,
LDH,4113012,CDM,300,RC,83615,HCPCS,Outpatient,,,83.5,41.75,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,6.35,66.8,
CPK,4113013,CDM,301,RC,82550,HCPCS,Outpatient,,,114.5,57.25,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,6.35,91.6,
AMYLASE,4113014,CDM,301,RC,82150,HCPCS,Outpatient,,,130,65,,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,97.5,75,,,percent of total billed charges,75% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,104,80,,,percent of total billed charges,80% of total billed charges ,31.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,65.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.2,24,,,percent of total billed charges,24% of total billed charges ,40.56,31.2,,,percent of total billed charges,31.2% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,31.2,24,,,percent of total billed charges,24% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,8.15,104,
"TOTAL PROTEIN, SERUM",4113015,CDM,300,RC,84155,HCPCS,Outpatient,,,83.5,41.75,,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,4.61,66.8,
SERUM ACETONE,4113017,CDM,301,RC,82009,HCPCS,Outpatient,,,101,50.5,,4.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,4.13,80.8,
GLUCOSE,4113018,CDM,300,RC,82947,HCPCS,Outpatient,,,101,50.5,,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,4.93,80.8,
LEVETIRACETAM,4113020,CDM,301,RC,80177,HCPCS,Outpatient,,,274,137,,14.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,65.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,219.2,80,,,percent of total billed charges,80% of total billed charges ,66.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,138.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,205.5,75,,,percent of total billed charges,75% of total billed charges ,67.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,65.76,24,,,percent of total billed charges,24% of total billed charges ,85.49,31.2,,,percent of total billed charges,31.2% of total billed charges,219.2,80,,,percent of total billed charges,80% of total billed charges,65.76,24,,,percent of total billed charges,24% of total billed charges ,65.76,24,,,percent of total billed charges,24% of total billed charges ,14.47,219.2,
METHANOL,4113021,CDM,301,RC,80320,HCPCS,Outpatient,,,76,38,,13.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60.8,80,,,percent of total billed charges,80% of total billed charges ,18.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,38.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,57,75,,,percent of total billed charges,75% of total billed charges ,18.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.24,24,,,percent of total billed charges,24% of total billed charges ,23.71,31.2,,,percent of total billed charges,31.2% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,18.24,24,,,percent of total billed charges,24% of total billed charges ,18.24,24,,,percent of total billed charges,24% of total billed charges ,13.59,60.8,
CARNITINE,4113023,CDM,301,RC,82379,HCPCS,Outpatient,,,237,118.5,,21.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,21.21,189.6,
CA 27-29,4113025,CDM,300,RC,86300,HCPCS,Outpatient,,,188.5,94.25,,26.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,141.38,75,,,percent of total billed charges,75% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,150.8,80,,,percent of total billed charges,80% of total billed charges ,45.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,95,50.4,,,percent of total billed charges,50.4% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,46.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.24,24,,,percent of total billed charges,24% of total billed charges ,58.81,31.2,,,percent of total billed charges,31.2% of total billed charges,150.8,80,,,percent of total billed charges,80% of total billed charges,45.24,24,,,percent of total billed charges,24% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,26.16,150.8,
UDS CCH,4113027,CDM,301,RC,80307,HCPCS,Outpatient,,,243,121.5,,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,194.4,80,,,percent of total billed charges,80% of total billed charges ,58.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,122.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,182.25,75,,,percent of total billed charges,75% of total billed charges ,59.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,58.32,24,,,percent of total billed charges,24% of total billed charges ,75.82,31.2,,,percent of total billed charges,31.2% of total billed charges,194.4,80,,,percent of total billed charges,80% of total billed charges,58.32,24,,,percent of total billed charges,24% of total billed charges ,58.32,24,,,percent of total billed charges,24% of total billed charges ,58.32,194.4,
LYME CONF WB,4113030,CDM,300,RC,86617,HCPCS,Outpatient,,,166,83,,19.48,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.48,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,19.48,132.8,
PANCREATIC POLYPEPTIDE,4113519,CDM,300,RC,83519,HCPCS,Outpatient,,,357.5,178.75,,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,286,80,,,percent of total billed charges,80% of total billed charges ,86.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,180.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,87.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.8,24,,,percent of total billed charges,24% of total billed charges ,111.54,31.2,,,percent of total billed charges,31.2% of total billed charges,286,80,,,percent of total billed charges,80% of total billed charges,85.8,24,,,percent of total billed charges,24% of total billed charges ,85.8,24,,,percent of total billed charges,24% of total billed charges ,16.99,286,
AFB CULTURE,4115000,CDM,300,RC,87116,HCPCS,Outpatient,,,166,83,,44.59,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,44.59,26.86,,,percent of total billed charges,26.86% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,132.8,
AFB SMEAR,4115001,CDM,300,RC,87206,HCPCS,Outpatient,,,96,48,,6.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,6.75,76.8,
BLOOD CULTURE,4115002,CDM,300,RC,87040,HCPCS,Outpatient,,,199,99.5,,12.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,12.98,159.2,
FUNGAL CULTURE,4115004,CDM,300,RC,87101,HCPCS,Outpatient,,,166,83,,9.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,9.69,132.8,
KOH PREP,4115007,CDM,300,RC,87210,HCPCS,Outpatient,,,86.5,43.25,,5.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,64.88,75,,,percent of total billed charges,75% of total billed charges ,64.88,75,,,percent of total billed charges,75% of total billed charges ,20.76,24,,,percent of total billed charges,24% of total billed charges ,64.88,75,,,percent of total billed charges,75% of total billed charges ,64.88,75,,,percent of total billed charges,75% of total billed charges ,69.2,80,,,percent of total billed charges,80% of total billed charges ,20.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,43.6,50.4,,,percent of total billed charges,50.4% of total billed charges ,64.88,75,,,percent of total billed charges,75% of total billed charges ,21.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.76,24,,,percent of total billed charges,24% of total billed charges ,26.99,31.2,,,percent of total billed charges,31.2% of total billed charges,69.2,80,,,percent of total billed charges,80% of total billed charges,20.76,24,,,percent of total billed charges,24% of total billed charges ,20.76,24,,,percent of total billed charges,24% of total billed charges ,5.36,69.2,
OCCULT BLOOD,4115008,CDM,301,RC,82270,HCPCS,Outpatient,,,101,50.5,,4.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,4.04,80.8,
ROUTINE CULTURE,4115010,CDM,300,RC,87070,HCPCS,Outpatient,,,199,99.5,,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,10.83,159.2,
GRAM STAIN,4115011,CDM,300,RC,87205,HCPCS,Outpatient,,,83.5,41.75,,2.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,2.95,66.8,
THROAT OR NP CULTURE,4115012,CDM,300,RC,87070,HCPCS,Outpatient,,,119.5,59.75,,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,10.83,95.6,
CCP IGG,4115015,CDM,300,RC,86200,HCPCS,Outpatient,,,357.5,178.75,,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,286,80,,,percent of total billed charges,80% of total billed charges ,86.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,180.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,87.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.8,24,,,percent of total billed charges,24% of total billed charges ,111.54,31.2,,,percent of total billed charges,31.2% of total billed charges,286,80,,,percent of total billed charges,80% of total billed charges,85.8,24,,,percent of total billed charges,24% of total billed charges ,85.8,24,,,percent of total billed charges,24% of total billed charges ,16.28,286,
URINE SG,4116003,CDM,307,RC,81003,HCPCS,Outpatient,,,72,36,,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,2.83,57.6,
URINE PH,4116004,CDM,300,RC,81003,HCPCS,Outpatient,,,72,36,,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,2.83,57.6,
URINE DIPSTICK ANALYSIS CHG,4116005,CDM,307,RC,81003,HCPCS,Outpatient,,,72,36,,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,2.83,57.6,
URINE GLUCOSE,4116006,CDM,307,RC,81003,HCPCS,Outpatient,,,72,36,,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,2.83,57.6,
URINE ACETONE,4116007,CDM,307,RC,81002,HCPCS,Outpatient,,,72,36,,3.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,3.21,57.6,
URINE BILE,4116008,CDM,307,RC,81002,HCPCS,Outpatient,,,72,36,,3.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,3.21,57.6,
URINE BLOOD,4116009,CDM,307,RC,81003,HCPCS,Outpatient,,,72,36,,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,2.83,57.6,
PREG TEST URINE,4116012,CDM,300,RC,81025,HCPCS,Outpatient,,,101,50.5,,7.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,7.96,80.8,
"CRYSTALS, SYNOVIAL FLUID",4116013,CDM,300,RC,89060,HCPCS,Outpatient,,,83.5,41.75,,8.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,8.99,66.8,
URINE MICROSCOPIC REFLEX,4116014,CDM,307,RC,81001,HCPCS,Outpatient,,,86.5,43.25,,3.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,64.88,75,,,percent of total billed charges,75% of total billed charges ,64.88,75,,,percent of total billed charges,75% of total billed charges ,20.76,24,,,percent of total billed charges,24% of total billed charges ,64.88,75,,,percent of total billed charges,75% of total billed charges ,64.88,75,,,percent of total billed charges,75% of total billed charges ,69.2,80,,,percent of total billed charges,80% of total billed charges ,20.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,43.6,50.4,,,percent of total billed charges,50.4% of total billed charges ,64.88,75,,,percent of total billed charges,75% of total billed charges ,21.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.76,24,,,percent of total billed charges,24% of total billed charges ,26.99,31.2,,,percent of total billed charges,31.2% of total billed charges,69.2,80,,,percent of total billed charges,80% of total billed charges,20.76,24,,,percent of total billed charges,24% of total billed charges ,20.76,24,,,percent of total billed charges,24% of total billed charges ,3.99,69.2,
"CELL COUNT, BODY FLUID, OTHER",4116032,CDM,300,RC,89051,HCPCS,Outpatient,,,72,36,,2.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,2.21,57.6,
BB SPECIMEN HANDLING,4116034,CDM,300,RC,99001,HCPCS,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,41.2,
VAP,4116035,CDM,300,RC,83701,HCPCS,Outpatient,,,297.5,148.75,,31.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,238,80,,,percent of total billed charges,80% of total billed charges ,72.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,149.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,72.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,24,,,percent of total billed charges,24% of total billed charges ,92.82,31.2,,,percent of total billed charges,31.2% of total billed charges,238,80,,,percent of total billed charges,80% of total billed charges,71.4,24,,,percent of total billed charges,24% of total billed charges ,71.4,24,,,percent of total billed charges,24% of total billed charges ,31.21,238,
NICOTINE,4116038,CDM,300,RC,80323,HCPCS,Outpatient,,,356.5,178.25,,37.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,37.75,285.2,
CHROMOGRANIN A,4116040,CDM,300,RC,86316,HCPCS,Outpatient,,,119.5,59.75,,26.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,26.16,95.6,
PHYTANIC ACID,4116045,CDM,301,RC,82726,HCPCS,Outpatient,,,119.5,59.75,,7.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,7.55,95.6,
VITAMIN A,4116050,CDM,300,RC,84590,HCPCS,Outpatient,,,119.5,59.75,,14.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,14.58,95.6,
ETHYLENE GLYCOL,4116051,CDM,301,RC,82693,HCPCS,Outpatient,,,297.5,148.75,,18.74,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,238,80,,,percent of total billed charges,80% of total billed charges ,72.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,149.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,72.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.74,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,24,,,percent of total billed charges,24% of total billed charges ,92.82,31.2,,,percent of total billed charges,31.2% of total billed charges,238,80,,,percent of total billed charges,80% of total billed charges,71.4,24,,,percent of total billed charges,24% of total billed charges ,71.4,24,,,percent of total billed charges,24% of total billed charges ,18.74,238,
BK VIRUS DNA QUANT,4116060,CDM,300,RC,87799,HCPCS,Outpatient,,,889,444.5,,238.79,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,213.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,711.2,80,,,percent of total billed charges,80% of total billed charges ,215.49,24.24,,,percent of total billed charges,24.24% of total billed charges ,448.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,666.75,75,,,percent of total billed charges,75% of total billed charges ,217.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,238.79,26.86,,,percent of total billed charges,26.86% of total billed charges,213.36,24,,,percent of total billed charges,24% of total billed charges ,277.37,31.2,,,percent of total billed charges,31.2% of total billed charges,711.2,80,,,percent of total billed charges,80% of total billed charges,213.36,24,,,percent of total billed charges,24% of total billed charges ,213.36,24,,,percent of total billed charges,24% of total billed charges ,213.36,711.2,
HEP C VIRAL RNA GENOTYPE 1 NS5A DRUG RES,4116064,CDM,300,RC,87902,HCPCS,Outpatient,,,1210.5,605.25,,109.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,907.88,75,,,percent of total billed charges,75% of total billed charges ,907.88,75,,,percent of total billed charges,75% of total billed charges ,290.52,24,,,percent of total billed charges,24% of total billed charges ,907.88,75,,,percent of total billed charges,75% of total billed charges ,907.88,75,,,percent of total billed charges,75% of total billed charges ,968.4,80,,,percent of total billed charges,80% of total billed charges ,293.43,24.24,,,percent of total billed charges,24.24% of total billed charges ,610.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,907.88,75,,,percent of total billed charges,75% of total billed charges ,296.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,109.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,290.52,24,,,percent of total billed charges,24% of total billed charges ,377.68,31.2,,,percent of total billed charges,31.2% of total billed charges,968.4,80,,,percent of total billed charges,80% of total billed charges,290.52,24,,,percent of total billed charges,24% of total billed charges ,290.52,24,,,percent of total billed charges,24% of total billed charges ,109.67,968.4,
BB ANTIBODY ID CCH,4116067,CDM,300,RC,86870,HCPCS,Outpatient,,,213,106.5,,6.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,6.12,170.4,
BB DAT SHEPEARD,4116069,CDM,300,RC,86880,HCPCS,Outpatient,,,159.5,79.75,,6.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,127.6,80,,,percent of total billed charges,80% of total billed charges ,38.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,80.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,39.05,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,38.28,24,,,percent of total billed charges,24% of total billed charges ,49.76,31.2,,,percent of total billed charges,31.2% of total billed charges,127.6,80,,,percent of total billed charges,80% of total billed charges,38.28,24,,,percent of total billed charges,24% of total billed charges ,38.28,24,,,percent of total billed charges,24% of total billed charges ,6.75,127.6,
BB RBC ELUTION SHEP,4116072,CDM,300,RC,86860,HCPCS,Outpatient,,,213,106.5,,6.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,6.12,170.4,
GLUTAMIC ACID ABY,4116076,CDM,300,RC,86341,HCPCS,Outpatient,,,166,83,,24.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,24.89,132.8,
ISLET CELL AB IGG,4116077,CDM,300,RC,86341,HCPCS,Outpatient,,,166,83,,24.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,24.89,132.8,
TSH3,4116078,CDM,300,RC,84443,HCPCS,Outpatient,,,199,99.5,,21.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,149.25,75,,,percent of total billed charges,75% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,21.12,159.2,
T3 FREE,4116080,CDM,300,RC,84481,HCPCS,Outpatient,,,108,54,,21.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,21.3,86.4,
URINE CORTISOL FREE,4116081,CDM,301,RC,82530,HCPCS,Outpatient,,,166,83,,21.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,21.02,132.8,
QUETIAPINE,4116083,CDM,301,RC,80299,HCPCS,Outpatient,,,356.5,178.25,,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,15.14,285.2,
RENAL STONE ANALYSIS,4116084,CDM,301,RC,82365,HCPCS,Outpatient,,,108,54,,16.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,16.21,86.4,
D-DIMER,4116085,CDM,300,RC,85379,HCPCS,Outpatient,,,199,99.5,,12.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,12.8,159.2,
BB ANTIBODY SCREEN CCH,4117005,CDM,300,RC,86850,HCPCS,Outpatient,,,357.5,178.75,,15.23,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,286,80,,,percent of total billed charges,80% of total billed charges ,86.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,180.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,87.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.23,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.8,24,,,percent of total billed charges,24% of total billed charges ,111.54,31.2,,,percent of total billed charges,31.2% of total billed charges,286,80,,,percent of total billed charges,80% of total billed charges,85.8,24,,,percent of total billed charges,24% of total billed charges ,85.8,24,,,percent of total billed charges,24% of total billed charges ,15.23,286,
BB UNIT AG SCRN CCH,4117006,CDM,300,RC,86902,HCPCS,Outpatient,,,178,89,,4.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,4.3,142.4,
MONOSPOT,4118000,CDM,300,RC,86308,HCPCS,Outpatient,,,130,65,,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,97.5,75,,,percent of total billed charges,75% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,104,80,,,percent of total billed charges,80% of total billed charges ,31.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,65.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.2,24,,,percent of total billed charges,24% of total billed charges ,40.56,31.2,,,percent of total billed charges,31.2% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,31.2,24,,,percent of total billed charges,24% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,6.51,104,
RHEUMATIOD FACTOR,4118001,CDM,300,RC,86431,HCPCS,Outpatient,,,130,65,,7.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,97.5,75,,,percent of total billed charges,75% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,104,80,,,percent of total billed charges,80% of total billed charges ,31.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,65.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.2,24,,,percent of total billed charges,24% of total billed charges ,40.56,31.2,,,percent of total billed charges,31.2% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,31.2,24,,,percent of total billed charges,24% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,7.14,104,
RPR w/ REFLEX TO TITER & CONFIRM.,4118003,CDM,300,RC,86592,HCPCS,Outpatient,,,101,50.5,,4.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,4.65,80.8,
RUBELLA IGG,4118004,CDM,300,RC,86762,HCPCS,Outpatient,,,108,54,,14.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,81,75,,,percent of total billed charges,75% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,14.63,86.4,
THERAPEUTIC PHLEBOTOMY,4118011,CDM,300,RC,86900,HCPCS,Outpatient,,,122.5,61.25,,3.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,98,80,,,percent of total billed charges,80% of total billed charges ,29.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.4,24,,,percent of total billed charges,24% of total billed charges ,38.22,31.2,,,percent of total billed charges,31.2% of total billed charges,98,80,,,percent of total billed charges,80% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,3.75,98,
BB DIRECT COOMBS IGG CCH,4118014,CDM,300,RC,86880,HCPCS,Outpatient,,,83.5,41.75,,6.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,6.75,66.8,
ACETAMINOPHEN (TYLENOL) ASSAY,4119005,CDM,301,RC,80143,HCPCS,Outpatient,,,243,121.5,,14.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,194.4,80,,,percent of total billed charges,80% of total billed charges ,58.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,122.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,182.25,75,,,percent of total billed charges,75% of total billed charges ,59.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,58.32,24,,,percent of total billed charges,24% of total billed charges ,75.82,31.2,,,percent of total billed charges,31.2% of total billed charges,194.4,80,,,percent of total billed charges,80% of total billed charges,58.32,24,,,percent of total billed charges,24% of total billed charges ,58.32,24,,,percent of total billed charges,24% of total billed charges ,14.91,194.4,
QUICK STREP,4119006,CDM,300,RC,87430,HCPCS,Outpatient,,,101,50.5,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,15.08,80.8,
ROCK MT RICKETTSIA IGG,4119007,CDM,300,RC,86757,HCPCS,Outpatient,,,213,106.5,,24.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,159.75,75,,,percent of total billed charges,75% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,24.35,170.4,
BB AG TYPE NON RH SHEP,4119010,CDM,300,RC,86905,HCPCS,Outpatient,,,234,117,,4.81,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,187.2,80,,,percent of total billed charges,80% of total billed charges ,56.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,117.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,175.5,75,,,percent of total billed charges,75% of total billed charges ,57.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.81,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.16,24,,,percent of total billed charges,24% of total billed charges ,73.01,31.2,,,percent of total billed charges,31.2% of total billed charges,187.2,80,,,percent of total billed charges,80% of total billed charges,56.16,24,,,percent of total billed charges,24% of total billed charges ,56.16,24,,,percent of total billed charges,24% of total billed charges ,4.81,187.2,
PROSTATIC ACID PHOSPHATASE,4119013,CDM,300,RC,84066,HCPCS,Outpatient,,,108,54,,12.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,12.15,86.4,
ALK PHOS ISO,4119014,CDM,300,RC,84080,HCPCS,Outpatient,,,188.5,94.25,,18.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.8,80,,,percent of total billed charges,80% of total billed charges ,45.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,95,50.4,,,percent of total billed charges,50.4% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,46.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.24,24,,,percent of total billed charges,24% of total billed charges ,58.81,31.2,,,percent of total billed charges,31.2% of total billed charges,150.8,80,,,percent of total billed charges,80% of total billed charges,45.24,24,,,percent of total billed charges,24% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,18.59,150.8,
AMMONIA,4119016,CDM,301,RC,82140,HCPCS,Outpatient,,,170,85,,12.44,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,136,80,,,percent of total billed charges,80% of total billed charges ,41.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,85.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,41.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.44,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,24,,,percent of total billed charges,24% of total billed charges ,53.04,31.2,,,percent of total billed charges,31.2% of total billed charges,136,80,,,percent of total billed charges,80% of total billed charges,40.8,24,,,percent of total billed charges,24% of total billed charges ,40.8,24,,,percent of total billed charges,24% of total billed charges ,12.44,136,
ANA,4119017,CDM,300,RC,86038,HCPCS,Outpatient,,,170,85,,15.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,136,80,,,percent of total billed charges,80% of total billed charges ,41.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,85.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,41.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,24,,,percent of total billed charges,24% of total billed charges ,53.04,31.2,,,percent of total billed charges,31.2% of total billed charges,136,80,,,percent of total billed charges,80% of total billed charges,40.8,24,,,percent of total billed charges,24% of total billed charges ,40.8,24,,,percent of total billed charges,24% of total billed charges ,15.2,136,
URINE 24 HR CATECHOLAMINES,4119022,CDM,300,RC,82384,HCPCS,Outpatient,,,356.5,178.25,,31.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,31.75,285.2,
CEA,4119023,CDM,301,RC,82378,HCPCS,Outpatient,,,214,107,,23.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,171.2,80,,,percent of total billed charges,80% of total billed charges ,51.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,52.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.36,24,,,percent of total billed charges,24% of total billed charges ,66.77,31.2,,,percent of total billed charges,31.2% of total billed charges,171.2,80,,,percent of total billed charges,80% of total billed charges,51.36,24,,,percent of total billed charges,24% of total billed charges ,51.36,24,,,percent of total billed charges,24% of total billed charges ,23.86,171.2,
CHOLESTEROL,4119024,CDM,301,RC,82465,HCPCS,Outpatient,,,130,65,,5.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,97.5,75,,,percent of total billed charges,75% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,104,80,,,percent of total billed charges,80% of total billed charges ,31.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,65.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.2,24,,,percent of total billed charges,24% of total billed charges ,40.56,31.2,,,percent of total billed charges,31.2% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,31.2,24,,,percent of total billed charges,24% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,5.47,104,
HUMAN GROWTH HORMONE,4119025,CDM,300,RC,83003,HCPCS,Outpatient,,,166,83,,17.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,17.9,132.8,
CPK ISOENZYMES,4119026,CDM,301,RC,82552,HCPCS,Outpatient,,,213,106.5,,16.84,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.84,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,16.84,170.4,
DIGOXIN,4119027,CDM,301,RC,80162,HCPCS,Outpatient,,,199,99.5,,16.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,16.7,159.2,
PHENYTOIN TOTAL,4119028,CDM,301,RC,80185,HCPCS,Outpatient,,,166,83,,16.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,16.67,132.8,
"MEDICAL DRUG SCREEN & CONFIRM., URINE",4119030,CDM,301,RC,80307,HCPCS,Outpatient,,,243,121.5,,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,194.4,80,,,percent of total billed charges,80% of total billed charges ,58.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,122.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,182.25,75,,,percent of total billed charges,75% of total billed charges ,59.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,58.32,24,,,percent of total billed charges,24% of total billed charges ,75.82,31.2,,,percent of total billed charges,31.2% of total billed charges,194.4,80,,,percent of total billed charges,80% of total billed charges,58.32,24,,,percent of total billed charges,24% of total billed charges ,58.32,24,,,percent of total billed charges,24% of total billed charges ,58.32,194.4,
FOLATE,4119032,CDM,301,RC,82746,HCPCS,Outpatient,,,199,99.5,,18.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,18.49,159.2,
GGTP,4119035,CDM,300,RC,82977,HCPCS,Outpatient,,,144,72,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,115.2,80,,,percent of total billed charges,80% of total billed charges ,34.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,35.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.56,24,,,percent of total billed charges,24% of total billed charges ,44.93,31.2,,,percent of total billed charges,31.2% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,6.35,115.2,
HEMOGLOBIN ELECTROPHORESIS,4119038,CDM,300,RC,83020,HCPCS,Outpatient,,,213,106.5,,12.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,12.29,170.4,
HEP B CORE AB,4119039,CDM,300,RC,86704,HCPCS,Outpatient,,,357.5,178.75,,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,268.13,75,,,percent of total billed charges,75% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,85.8,24,,,percent of total billed charges,24% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,286,80,,,percent of total billed charges,80% of total billed charges ,86.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,180.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,87.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.8,24,,,percent of total billed charges,24% of total billed charges ,111.54,31.2,,,percent of total billed charges,31.2% of total billed charges,286,80,,,percent of total billed charges,80% of total billed charges,85.8,24,,,percent of total billed charges,24% of total billed charges ,85.8,24,,,percent of total billed charges,24% of total billed charges ,15.16,286,
TIBC,4119040,CDM,300,RC,83550,HCPCS,Outpatient,,,1,0.5,,10.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.8,80,,,percent of total billed charges,80% of total billed charges ,0.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,0.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.31,31.2,,,percent of total billed charges,31.2% of total billed charges,0.8,80,,,percent of total billed charges,80% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,10.99,
IRON,4119041,CDM,300,RC,83540,HCPCS,Outpatient,,,170,85,,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,136,80,,,percent of total billed charges,80% of total billed charges ,41.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,85.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,41.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,24,,,percent of total billed charges,24% of total billed charges ,53.04,31.2,,,percent of total billed charges,31.2% of total billed charges,136,80,,,percent of total billed charges,80% of total billed charges,40.8,24,,,percent of total billed charges,24% of total billed charges ,40.8,24,,,percent of total billed charges,24% of total billed charges ,8.15,136,
LDH ISOENZYMES,4119049,CDM,300,RC,83625,HCPCS,Outpatient,,,166,83,,14.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,14.55,132.8,
LIPASE,4119050,CDM,300,RC,83690,HCPCS,Outpatient,,,199,99.5,,8.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,8.66,159.2,
LITHIUM,4119052,CDM,301,RC,80178,HCPCS,Outpatient,,,166,83,,8.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,8.32,132.8,
MAGNESIUM,4119054,CDM,300,RC,83735,HCPCS,Outpatient,,,130,65,,8.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,104,80,,,percent of total billed charges,80% of total billed charges ,31.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,65.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.2,24,,,percent of total billed charges,24% of total billed charges ,40.56,31.2,,,percent of total billed charges,31.2% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,31.2,24,,,percent of total billed charges,24% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,8.42,104,
PRIMIDONE,4119057,CDM,301,RC,80188,HCPCS,Outpatient,,,277,138.5,,20.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,20.86,221.6,
OSMOLALITY SERUM,4119058,CDM,301,RC,83930,HCPCS,Outpatient,,,108,54,,8.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,8.32,86.4,
URINE PHOSPHORUS,4119059,CDM,300,RC,84105,HCPCS,Outpatient,,,108,54,,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,6.51,86.4,
"PORPHYRINS QUANT, URINE RANDOM",4119060,CDM,300,RC,84120,HCPCS,Outpatient,,,188.5,94.25,,18.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.8,80,,,percent of total billed charges,80% of total billed charges ,45.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,95,50.4,,,percent of total billed charges,50.4% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,46.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.24,24,,,percent of total billed charges,24% of total billed charges ,58.81,31.2,,,percent of total billed charges,31.2% of total billed charges,150.8,80,,,percent of total billed charges,80% of total billed charges,45.24,24,,,percent of total billed charges,24% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,18.5,150.8,
PROTEIN ELECTROPHORESIS SERUM,4119063,CDM,300,RC,84165,HCPCS,Outpatient,,,199,99.5,,13.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,13.51,159.2,
"PROTEIN ELECTROPHORESIS, URINE 24 HR",4119064,CDM,300,RC,84166,HCPCS,Outpatient,,,141,70.5,,22.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,112.8,80,,,percent of total billed charges,80% of total billed charges ,34.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,71.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,34.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.84,24,,,percent of total billed charges,24% of total billed charges ,43.99,31.2,,,percent of total billed charges,31.2% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,33.84,24,,,percent of total billed charges,24% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,22.43,112.8,
URINE TOTAL PROTEIN,4119065,CDM,301,RC,84156,HCPCS,Outpatient,,,130,65,,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,104,80,,,percent of total billed charges,80% of total billed charges ,31.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,65.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.2,24,,,percent of total billed charges,24% of total billed charges ,40.56,31.2,,,percent of total billed charges,31.2% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,31.2,24,,,percent of total billed charges,24% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,4.61,104,
RENIN,4119066,CDM,300,RC,84244,HCPCS,Outpatient,,,203,101.5,,27.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,162.4,80,,,percent of total billed charges,80% of total billed charges ,49.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,102.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,152.25,75,,,percent of total billed charges,75% of total billed charges ,49.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,48.72,24,,,percent of total billed charges,24% of total billed charges ,63.34,31.2,,,percent of total billed charges,31.2% of total billed charges,162.4,80,,,percent of total billed charges,80% of total billed charges,48.72,24,,,percent of total billed charges,24% of total billed charges ,48.72,24,,,percent of total billed charges,24% of total billed charges ,27.66,162.4,
T3 UPTAKE,4119068,CDM,300,RC,84479,HCPCS,Outpatient,,,144,72,,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,115.2,80,,,percent of total billed charges,80% of total billed charges ,34.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,35.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.56,24,,,percent of total billed charges,24% of total billed charges ,44.93,31.2,,,percent of total billed charges,31.2% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,8.14,115.2,
T4 TOTAL,4119070,CDM,300,RC,84436,HCPCS,Outpatient,,,144,72,,8.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,115.2,80,,,percent of total billed charges,80% of total billed charges ,34.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,35.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.56,24,,,percent of total billed charges,24% of total billed charges ,44.93,31.2,,,percent of total billed charges,31.2% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,8.65,115.2,
"CARBAMAZEPINE, TOTAL",4119073,CDM,301,RC,80156,HCPCS,Outpatient,,,243,121.5,,18.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,194.4,80,,,percent of total billed charges,80% of total billed charges ,58.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,122.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,182.25,75,,,percent of total billed charges,75% of total billed charges ,59.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,58.32,24,,,percent of total billed charges,24% of total billed charges ,75.82,31.2,,,percent of total billed charges,31.2% of total billed charges,194.4,80,,,percent of total billed charges,80% of total billed charges,58.32,24,,,percent of total billed charges,24% of total billed charges ,58.32,24,,,percent of total billed charges,24% of total billed charges ,18.31,194.4,
"THEOPHYLLINE, TROUGH",4119074,CDM,301,RC,80198,HCPCS,Outpatient,,,166,83,,17.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,17.79,132.8,
TRIGLYCERIDES,4119076,CDM,300,RC,84478,HCPCS,Outpatient,,,170,85,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,127.5,75,,,percent of total billed charges,75% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,40.8,24,,,percent of total billed charges,24% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,136,80,,,percent of total billed charges,80% of total billed charges ,41.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,85.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,41.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,24,,,percent of total billed charges,24% of total billed charges ,53.04,31.2,,,percent of total billed charges,31.2% of total billed charges,136,80,,,percent of total billed charges,80% of total billed charges,40.8,24,,,percent of total billed charges,24% of total billed charges ,40.8,24,,,percent of total billed charges,24% of total billed charges ,6.35,136,
URINE URIC ACID,4119079,CDM,300,RC,84560,HCPCS,Outpatient,,,108,54,,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,5.98,86.4,
VITAMIN B12,4119081,CDM,301,RC,82607,HCPCS,Outpatient,,,255.5,127.75,,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,204.4,80,,,percent of total billed charges,80% of total billed charges ,61.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,128.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,191.63,75,,,percent of total billed charges,75% of total billed charges ,62.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.32,24,,,percent of total billed charges,24% of total billed charges ,79.72,31.2,,,percent of total billed charges,31.2% of total billed charges,204.4,80,,,percent of total billed charges,80% of total billed charges,61.32,24,,,percent of total billed charges,24% of total billed charges ,61.32,24,,,percent of total billed charges,24% of total billed charges ,18.95,204.4,
URINE 24 HR VMA,4119082,CDM,300,RC,84585,HCPCS,Outpatient,,,213,106.5,,19.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,19.49,170.4,
"URINE CALCIUM, RANDOM",4119095,CDM,301,RC,82340,HCPCS,Outpatient,,,108,54,,7.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,7.59,86.4,
ALDOSTERONE,4119100,CDM,301,RC,82088,HCPCS,Outpatient,,,356.5,178.25,,51.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,51.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,51.25,285.2,
GENTAMICIN TROUGH,4119101,CDM,301,RC,80170,HCPCS,Outpatient,,,166,83,,20.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,20.61,132.8,
ANTI-STREPTOLYSIN O ANTIBODY,4119103,CDM,300,RC,86060,HCPCS,Outpatient,,,119.5,59.75,,8.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,8.79,95.6,
URINE 24HR 17OHCS,4119104,CDM,300,RC,83491,HCPCS,Outpatient,,,166,83,,22.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,22.02,132.8,
CRYOGLOBULIN,4119105,CDM,301,RC,82595,HCPCS,Outpatient,,,108,54,,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,8.14,86.4,
OXALATE SERUM,4119106,CDM,300,RC,83945,HCPCS,Outpatient,,,166,83,,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,16.19,132.8,
CARDIQUIN,4119108,CDM,301,RC,80194,HCPCS,Outpatient,,,166,83,,18.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,18.35,132.8,
MYOGLOBIN BLOOD,4119109,CDM,300,RC,83874,HCPCS,Outpatient,,,188.5,94.25,,16.24,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.8,80,,,percent of total billed charges,80% of total billed charges ,45.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,95,50.4,,,percent of total billed charges,50.4% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,46.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.24,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.24,24,,,percent of total billed charges,24% of total billed charges ,58.81,31.2,,,percent of total billed charges,31.2% of total billed charges,150.8,80,,,percent of total billed charges,80% of total billed charges,45.24,24,,,percent of total billed charges,24% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,16.24,150.8,
RBC FOLATE,4119114,CDM,301,RC,82747,HCPCS,Outpatient,,,188.5,94.25,,21.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.8,80,,,percent of total billed charges,80% of total billed charges ,45.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,95,50.4,,,percent of total billed charges,50.4% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,46.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.24,24,,,percent of total billed charges,24% of total billed charges ,58.81,31.2,,,percent of total billed charges,31.2% of total billed charges,150.8,80,,,percent of total billed charges,80% of total billed charges,45.24,24,,,percent of total billed charges,24% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,21.78,150.8,
DS DNA  AB,4119115,CDM,300,RC,86225,HCPCS,Outpatient,,,166,83,,17.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,17.28,132.8,
LEAD,4119119,CDM,300,RC,83655,HCPCS,Outpatient,,,199,99.5,,10,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,149.25,75,,,percent of total billed charges,75% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,10,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,10,159.2,
URINE DIPSTICK TEST,4119123,CDM,307,RC,81002,HCPCS,Outpatient,,,,,,3.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.21,3.21,
URINE 5 HIAA,4119124,CDM,300,RC,83497,HCPCS,Outpatient,,,320.5,160.25,,16.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,256.4,80,,,percent of total billed charges,80% of total billed charges ,77.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,161.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,240.38,75,,,percent of total billed charges,75% of total billed charges ,78.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,76.92,24,,,percent of total billed charges,24% of total billed charges ,100,31.2,,,percent of total billed charges,31.2% of total billed charges,256.4,80,,,percent of total billed charges,80% of total billed charges,76.92,24,,,percent of total billed charges,24% of total billed charges ,76.92,24,,,percent of total billed charges,24% of total billed charges ,16.21,256.4,
ALDOLASE,4119126,CDM,301,RC,82085,HCPCS,Outpatient,,,119.5,59.75,,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,12.2,95.6,
SALICYLATE,4119129,CDM,301,RC,80179,HCPCS,Outpatient,,,199,99.5,,14.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,14.91,159.2,
ALUMINUM,4119131,CDM,301,RC,82108,HCPCS,Outpatient,,,166,83,,21.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,21.2,132.8,
6 HR GLU TOL,4119134,CDM,300,RC,82951,HCPCS,Outpatient,,,474,237,,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,355.5,75,,,percent of total billed charges,75% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,379.2,80,,,percent of total billed charges,80% of total billed charges ,114.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,238.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,116.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,113.76,24,,,percent of total billed charges,24% of total billed charges ,147.89,31.2,,,percent of total billed charges,31.2% of total billed charges,379.2,80,,,percent of total billed charges,80% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,16.19,379.2,
TESTOSTERONE TOTAL,4119139,CDM,300,RC,84403,HCPCS,Outpatient,,,272,136,,32.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,65.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,32.47,217.6,
INSULIN AUTOANTIBODY,4119141,CDM,300,RC,86337,HCPCS,Outpatient,,,225.5,112.75,,26.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,169.13,75,,,percent of total billed charges,75% of total billed charges ,169.13,75,,,percent of total billed charges,75% of total billed charges ,54.12,24,,,percent of total billed charges,24% of total billed charges ,169.13,75,,,percent of total billed charges,75% of total billed charges ,169.13,75,,,percent of total billed charges,75% of total billed charges ,180.4,80,,,percent of total billed charges,80% of total billed charges ,54.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,113.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,169.13,75,,,percent of total billed charges,75% of total billed charges ,55.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.12,24,,,percent of total billed charges,24% of total billed charges ,70.36,31.2,,,percent of total billed charges,31.2% of total billed charges,180.4,80,,,percent of total billed charges,80% of total billed charges,54.12,24,,,percent of total billed charges,24% of total billed charges ,54.12,24,,,percent of total billed charges,24% of total billed charges ,26.93,180.4,
LEGIONELLA PNEUMO AB IGG,4119145,CDM,300,RC,86713,HCPCS,Outpatient,,,380,190,,19.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,285,75,,,percent of total billed charges,75% of total billed charges ,285,75,,,percent of total billed charges,75% of total billed charges ,91.2,24,,,percent of total billed charges,24% of total billed charges ,285,75,,,percent of total billed charges,75% of total billed charges ,285,75,,,percent of total billed charges,75% of total billed charges ,304,80,,,percent of total billed charges,80% of total billed charges ,92.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,191.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,285,75,,,percent of total billed charges,75% of total billed charges ,93.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,91.2,24,,,percent of total billed charges,24% of total billed charges ,118.56,31.2,,,percent of total billed charges,31.2% of total billed charges,304,80,,,percent of total billed charges,80% of total billed charges,91.2,24,,,percent of total billed charges,24% of total billed charges ,91.2,24,,,percent of total billed charges,24% of total billed charges ,19.25,304,
ESTROGEN,4119147,CDM,300,RC,82672,HCPCS,Outpatient,,,357.5,178.75,,20.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,286,80,,,percent of total billed charges,80% of total billed charges ,86.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,180.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,87.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.8,24,,,percent of total billed charges,24% of total billed charges ,111.54,31.2,,,percent of total billed charges,31.2% of total billed charges,286,80,,,percent of total billed charges,80% of total billed charges,85.8,24,,,percent of total billed charges,24% of total billed charges ,85.8,24,,,percent of total billed charges,24% of total billed charges ,20.94,286,
URINE MYOGLOBIN,4119148,CDM,300,RC,83874,HCPCS,Outpatient,,,188.5,94.25,,16.24,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.8,80,,,percent of total billed charges,80% of total billed charges ,45.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,95,50.4,,,percent of total billed charges,50.4% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,46.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.24,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.24,24,,,percent of total billed charges,24% of total billed charges ,58.81,31.2,,,percent of total billed charges,31.2% of total billed charges,150.8,80,,,percent of total billed charges,80% of total billed charges,45.24,24,,,percent of total billed charges,24% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,16.24,150.8,
AMIKACIN TROUGH,4119153,CDM,300,RC,80150,HCPCS,Outpatient,,,166,83,,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,18.95,132.8,
PREG TEST SERUM,4119155,CDM,300,RC,84703,HCPCS,Outpatient,,,114.5,57.25,,8.07,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.07,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,8.07,91.6,
TOBRAMYCIN,4119156,CDM,301,RC,80200,HCPCS,Outpatient,,,166,83,,18.84,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.84,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,18.84,132.8,
IONIZED CALCIUM,4119158,CDM,301,RC,82330,HCPCS,Outpatient,,,170,85,,17.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,136,80,,,percent of total billed charges,80% of total billed charges ,41.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,85.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,41.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,24,,,percent of total billed charges,24% of total billed charges ,53.04,31.2,,,percent of total billed charges,31.2% of total billed charges,136,80,,,percent of total billed charges,80% of total billed charges,40.8,24,,,percent of total billed charges,24% of total billed charges ,40.8,24,,,percent of total billed charges,24% of total billed charges ,17.18,136,
FSH,4119164,CDM,300,RC,83001,HCPCS,Outpatient,,,199,99.5,,23.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,149.25,75,,,percent of total billed charges,75% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,23.37,159.2,
LH,4119165,CDM,300,RC,83002,HCPCS,Outpatient,,,199,99.5,,23.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,149.25,75,,,percent of total billed charges,75% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,23.29,159.2,
AMYLASE ISO,4119166,CDM,301,RC,82150,HCPCS,Outpatient,,,166,83,,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,8.15,132.8,
CAROTENE,4119172,CDM,301,RC,82380,HCPCS,Outpatient,,,166,83,,11.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,11.6,132.8,
HIV 1/2 SCREEN,4119215,CDM,300,RC,86703,HCPCS,Outpatient,,,199,99.5,,14.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,149.25,75,,,percent of total billed charges,75% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,14.96,159.2,
"PSA, TOTAL",4119217,CDM,300,RC,84153,HCPCS,Outpatient,,,77.5,38.75,,23.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62,80,,,percent of total billed charges,80% of total billed charges ,18.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,18.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.6,24,,,percent of total billed charges,24% of total billed charges ,24.18,31.2,,,percent of total billed charges,31.2% of total billed charges,62,80,,,percent of total billed charges,80% of total billed charges,18.6,24,,,percent of total billed charges,24% of total billed charges ,18.6,24,,,percent of total billed charges,24% of total billed charges ,18.6,62,
ESTROGEN RECEPTOR [MOLES/MASS] IN TISSUE,4119221,CDM,300,RC,84233,HCPCS,Outpatient,,,474,237,,80.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,113.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,379.2,80,,,percent of total billed charges,80% of total billed charges ,114.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,238.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,116.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,80.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,113.76,24,,,percent of total billed charges,24% of total billed charges ,147.89,31.2,,,percent of total billed charges,31.2% of total billed charges,379.2,80,,,percent of total billed charges,80% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,80.99,379.2,
FERRITIN,4119223,CDM,301,RC,82728,HCPCS,Outpatient,,,199,99.5,,17.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,17.13,159.2,
ALPHA FETOPROTEIN,4119224,CDM,301,RC,82105,HCPCS,Outpatient,,,342,171,,21.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,82.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,273.6,80,,,percent of total billed charges,80% of total billed charges ,82.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,172.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,83.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,82.08,24,,,percent of total billed charges,24% of total billed charges ,106.7,31.2,,,percent of total billed charges,31.2% of total billed charges,273.6,80,,,percent of total billed charges,80% of total billed charges,82.08,24,,,percent of total billed charges,24% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,21.1,273.6,
CORTICOTROPIN,4119226,CDM,301,RC,82024,HCPCS,Outpatient,,,415,207.5,,48.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,99.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,332,80,,,percent of total billed charges,80% of total billed charges ,100.6,24.24,,,percent of total billed charges,24.24% of total billed charges ,209.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,311.25,75,,,percent of total billed charges,75% of total billed charges ,101.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,48.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,99.6,24,,,percent of total billed charges,24% of total billed charges ,129.48,31.2,,,percent of total billed charges,31.2% of total billed charges,332,80,,,percent of total billed charges,80% of total billed charges,99.6,24,,,percent of total billed charges,24% of total billed charges ,99.6,24,,,percent of total billed charges,24% of total billed charges ,48.57,332,
CARBOXYHEMOGLOBIN,4119228,CDM,301,RC,82375,HCPCS,Outpatient,,,141,70.5,,3.62,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,112.8,80,,,percent of total billed charges,80% of total billed charges ,34.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,71.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,34.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.62,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.84,24,,,percent of total billed charges,24% of total billed charges ,43.99,31.2,,,percent of total billed charges,31.2% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,33.84,24,,,percent of total billed charges,24% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,3.62,112.8,
TESTOSTERONE FREE,4119231,CDM,300,RC,84402,HCPCS,Outpatient,,,272,136,,32.01,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,65.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.01,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,32.01,217.6,
BNP,4119232,CDM,300,RC,83880,HCPCS,Outpatient,,,427.5,213.75,,42.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,320.63,75,,,percent of total billed charges,75% of total billed charges ,320.63,75,,,percent of total billed charges,75% of total billed charges ,102.6,24,,,percent of total billed charges,24% of total billed charges ,320.63,75,,,percent of total billed charges,75% of total billed charges ,320.63,75,,,percent of total billed charges,75% of total billed charges ,342,80,,,percent of total billed charges,80% of total billed charges ,103.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,215.46,50.4,,,percent of total billed charges,50.4% of total billed charges ,320.63,75,,,percent of total billed charges,75% of total billed charges ,104.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,42.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,102.6,24,,,percent of total billed charges,24% of total billed charges ,133.38,31.2,,,percent of total billed charges,31.2% of total billed charges,342,80,,,percent of total billed charges,80% of total billed charges,102.6,24,,,percent of total billed charges,24% of total billed charges ,102.6,24,,,percent of total billed charges,24% of total billed charges ,42.69,342,
DIRECT LDL,4119233,CDM,300,RC,83721,HCPCS,Outpatient,,,83.5,41.75,,12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,12,66.8,
HS CRP,4119235,CDM,300,RC,86141,HCPCS,Outpatient,,,119.5,59.75,,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,16.28,95.6,
GASTROCCULT,4119236,CDM,301,RC,82271,HCPCS,Outpatient,,,101,50.5,,4.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,4.04,80.8,
FLU A  AG QUICK SCRN,4119237,CDM,300,RC,87400,HCPCS,Outpatient,,,95,47.5,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,15.08,76,
FLU B AG QUICK SCRN,4119238,CDM,300,RC,87400,HCPCS,Outpatient,,,95,47.5,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,15.08,76,
PREALBUMIN,4119239,CDM,300,RC,84134,HCPCS,Outpatient,,,114.5,57.25,,18.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,18.34,91.6,
ESTRIOL,4119241,CDM,301,RC,82677,HCPCS,Outpatient,,,119.5,59.75,,30.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,95.6,
CBC W/MANUAL DIFF,4119245,CDM,300,RC,85007,HCPCS,Outpatient,,,83.5,41.75,,4.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,4.33,66.8,
ISTAT BMP,4119247,CDM,301,RC,80047,HCPCS,Outpatient,,,237,118.5,,27.46,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.46,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,27.46,189.6,
ACETYL REC BLOCK ANTIBODY,4119250,CDM,300,RC,83519,HCPCS,Outpatient,,,166,83,,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,16.99,132.8,
ACETYL REC MOD ANTIBODY,4119251,CDM,300,RC,83519,HCPCS,Outpatient,,,213,106.5,,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,16.99,170.4,
COMPLEMENT C3,4119252,CDM,300,RC,86160,HCPCS,Outpatient,,,48.5,24.25,,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.8,80,,,percent of total billed charges,80% of total billed charges ,11.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.64,24,,,percent of total billed charges,24% of total billed charges ,15.13,31.2,,,percent of total billed charges,31.2% of total billed charges,38.8,80,,,percent of total billed charges,80% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,38.8,
COMPLEMENT C4,4119253,CDM,300,RC,86160,HCPCS,Outpatient,,,48.5,24.25,,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.8,80,,,percent of total billed charges,80% of total billed charges ,11.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.64,24,,,percent of total billed charges,24% of total billed charges ,15.13,31.2,,,percent of total billed charges,31.2% of total billed charges,38.8,80,,,percent of total billed charges,80% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,38.8,
NMR PROFILE,4119254,CDM,300,RC,83704,HCPCS,Outpatient,,,328.5,164.25,,39.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,78.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,262.8,80,,,percent of total billed charges,80% of total billed charges ,79.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,165.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,246.38,75,,,percent of total billed charges,75% of total billed charges ,80.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,39.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,78.84,24,,,percent of total billed charges,24% of total billed charges ,102.49,31.2,,,percent of total billed charges,31.2% of total billed charges,262.8,80,,,percent of total billed charges,80% of total billed charges,78.84,24,,,percent of total billed charges,24% of total billed charges ,78.84,24,,,percent of total billed charges,24% of total billed charges ,39.67,262.8,
FACTOR IX ACTIVITY,4119257,CDM,300,RC,85250,HCPCS,Outpatient,,,225.5,112.75,,23.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,180.4,80,,,percent of total billed charges,80% of total billed charges ,54.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,113.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,169.13,75,,,percent of total billed charges,75% of total billed charges ,55.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.12,24,,,percent of total billed charges,24% of total billed charges ,70.36,31.2,,,percent of total billed charges,31.2% of total billed charges,180.4,80,,,percent of total billed charges,80% of total billed charges,54.12,24,,,percent of total billed charges,24% of total billed charges ,54.12,24,,,percent of total billed charges,24% of total billed charges ,23.94,180.4,
"VITAMIN D 1,25",4119262,CDM,301,RC,82652,HCPCS,Outpatient,,,243,121.5,,48.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,194.4,80,,,percent of total billed charges,80% of total billed charges ,58.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,122.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,182.25,75,,,percent of total billed charges,75% of total billed charges ,59.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,48.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,58.32,24,,,percent of total billed charges,24% of total billed charges ,75.82,31.2,,,percent of total billed charges,31.2% of total billed charges,194.4,80,,,percent of total billed charges,80% of total billed charges,58.32,24,,,percent of total billed charges,24% of total billed charges ,58.32,24,,,percent of total billed charges,24% of total billed charges ,48.4,194.4,
H1N1 FLU PCR,4119263,CDM,300,RC,87798,HCPCS,Outpatient,,,309,154.5,,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,74.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,247.2,80,,,percent of total billed charges,80% of total billed charges ,74.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,155.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,231.75,75,,,percent of total billed charges,75% of total billed charges ,75.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,74.16,24,,,percent of total billed charges,24% of total billed charges ,96.41,31.2,,,percent of total billed charges,31.2% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,74.16,24,,,percent of total billed charges,24% of total billed charges ,74.16,24,,,percent of total billed charges,24% of total billed charges ,24.67,247.2,
HEP A TOTAL AB,4119265,CDM,300,RC,86708,HCPCS,Outpatient,,,59.5,29.75,,15.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,47.6,
OXYCODONE BLOOD,4119266,CDM,300,RC,80365,HCPCS,Outpatient,,,284.5,142.25,,76.42,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,76.42,26.86,,,percent of total billed charges,26.86% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,227.6,
IGG SUBCLASS 1,4119267,CDM,301,RC,82787,HCPCS,Outpatient,,,59.5,29.75,,10.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,10.08,47.6,
IGG SUBCLASS 3,4119269,CDM,301,RC,82787,HCPCS,Outpatient,,,59.5,29.75,,10.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,10.08,47.6,
IGG SUBCLASS 4,4119270,CDM,301,RC,82787,HCPCS,Outpatient,,,59.5,29.75,,10.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,10.08,47.6,
SIROLIMUS,4119272,CDM,301,RC,80195,HCPCS,Outpatient,,,237,118.5,,17.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,17.25,189.6,
LATEX IGE AB RAST,4119273,CDM,300,RC,86003,HCPCS,Outpatient,,,59.5,29.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,6.57,47.6,
17 OH-PREGNENOLONE,4119275,CDM,300,RC,84143,HCPCS,Outpatient,,,345,172.5,,28.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,82.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,276,80,,,percent of total billed charges,80% of total billed charges ,83.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,173.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,258.75,75,,,percent of total billed charges,75% of total billed charges ,84.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,82.8,24,,,percent of total billed charges,24% of total billed charges ,107.64,31.2,,,percent of total billed charges,31.2% of total billed charges,276,80,,,percent of total billed charges,80% of total billed charges,82.8,24,,,percent of total billed charges,24% of total billed charges ,82.8,24,,,percent of total billed charges,24% of total billed charges ,28.7,276,
CBC WITHOUT DIFF,4119276,CDM,300,RC,85027,HCPCS,Outpatient,,,130,65,,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,97.5,75,,,percent of total billed charges,75% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,104,80,,,percent of total billed charges,80% of total billed charges ,31.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,65.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.2,24,,,percent of total billed charges,24% of total billed charges ,40.56,31.2,,,percent of total billed charges,31.2% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,31.2,24,,,percent of total billed charges,24% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,8.14,104,
RABIES AB TITER,4119277,CDM,300,RC,86790,HCPCS,Outpatient,,,356.5,178.25,,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,16.2,285.2,
"FECAL LACTOFERRIN, QUAL",4119278,CDM,300,RC,83630,HCPCS,Outpatient,,,199,99.5,,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,13.45,159.2,
APOLIPROTEIN B,4119279,CDM,301,RC,82172,HCPCS,Outpatient,,,203,101.5,,19.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,162.4,80,,,percent of total billed charges,80% of total billed charges ,49.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,102.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,152.25,75,,,percent of total billed charges,75% of total billed charges ,49.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,48.72,24,,,percent of total billed charges,24% of total billed charges ,63.34,31.2,,,percent of total billed charges,31.2% of total billed charges,162.4,80,,,percent of total billed charges,80% of total billed charges,48.72,24,,,percent of total billed charges,24% of total billed charges ,48.72,24,,,percent of total billed charges,24% of total billed charges ,19.49,162.4,
TRANSFERRIN RECEPTOR,4119281,CDM,300,RC,84238,HCPCS,Outpatient,,,260.5,130.25,,45.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,208.4,80,,,percent of total billed charges,80% of total billed charges ,63.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,131.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,195.38,75,,,percent of total billed charges,75% of total billed charges ,63.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,45.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.52,24,,,percent of total billed charges,24% of total billed charges ,81.28,31.2,,,percent of total billed charges,31.2% of total billed charges,208.4,80,,,percent of total billed charges,80% of total billed charges,62.52,24,,,percent of total billed charges,24% of total billed charges ,62.52,24,,,percent of total billed charges,24% of total billed charges ,45.98,208.4,
ANA (TITER CHARGE ONLY),4119283,CDM,300,RC,86039,HCPCS,Outpatient,,,77.5,38.75,,14.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62,80,,,percent of total billed charges,80% of total billed charges ,18.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,18.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.6,24,,,percent of total billed charges,24% of total billed charges ,24.18,31.2,,,percent of total billed charges,31.2% of total billed charges,62,80,,,percent of total billed charges,80% of total billed charges,18.6,24,,,percent of total billed charges,24% of total billed charges ,18.6,24,,,percent of total billed charges,24% of total billed charges ,14.04,62,
MUMPS VIRUS IGG,4119285,CDM,300,RC,86735,HCPCS,Outpatient,,,91.5,45.75,,16.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.63,75,,,percent of total billed charges,75% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,21.96,24,,,percent of total billed charges,24% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,73.2,80,,,percent of total billed charges,80% of total billed charges ,22.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,46.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,22.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.96,24,,,percent of total billed charges,24% of total billed charges ,28.55,31.2,,,percent of total billed charges,31.2% of total billed charges,73.2,80,,,percent of total billed charges,80% of total billed charges,21.96,24,,,percent of total billed charges,24% of total billed charges ,21.96,24,,,percent of total billed charges,24% of total billed charges ,16.41,73.2,
ESTRONE SULFATE,4119286,CDM,301,RC,82679,HCPCS,Outpatient,,,119.5,59.75,,31.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,95.6,
"URINE CITRIC ACID, 24 HR",4119287,CDM,301,RC,82507,HCPCS,Outpatient,,,73,36.5,,34.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,34.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,58.4,
THYROGLOBULIN QUANTATIVE,4119289,CDM,300,RC,84432,HCPCS,Outpatient,,,82.5,41.25,,20.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
6 MERCAPTOPURINE,4119290,CDM,301,RC,80299,HCPCS,Outpatient,,,254.5,127.25,,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,203.6,80,,,percent of total billed charges,80% of total billed charges ,61.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,128.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,190.88,75,,,percent of total billed charges,75% of total billed charges ,62.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.08,24,,,percent of total billed charges,24% of total billed charges ,79.4,31.2,,,percent of total billed charges,31.2% of total billed charges,203.6,80,,,percent of total billed charges,80% of total billed charges,61.08,24,,,percent of total billed charges,24% of total billed charges ,61.08,24,,,percent of total billed charges,24% of total billed charges ,15.14,203.6,
6 THIOGUANINE,4119291,CDM,301,RC,80299,HCPCS,Outpatient,,,254.5,127.25,,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,203.6,80,,,percent of total billed charges,80% of total billed charges ,61.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,128.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,190.88,75,,,percent of total billed charges,75% of total billed charges ,62.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.08,24,,,percent of total billed charges,24% of total billed charges ,79.4,31.2,,,percent of total billed charges,31.2% of total billed charges,203.6,80,,,percent of total billed charges,80% of total billed charges,61.08,24,,,percent of total billed charges,24% of total billed charges ,61.08,24,,,percent of total billed charges,24% of total billed charges ,15.14,203.6,
MYCOPHENOLIC ACID,4119293,CDM,301,RC,80180,HCPCS,Outpatient,,,645,322.5,,6.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,154.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,516,80,,,percent of total billed charges,80% of total billed charges ,156.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,325.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,483.75,75,,,percent of total billed charges,75% of total billed charges ,157.9,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,154.8,24,,,percent of total billed charges,24% of total billed charges ,201.24,31.2,,,percent of total billed charges,31.2% of total billed charges,516,80,,,percent of total billed charges,80% of total billed charges,154.8,24,,,percent of total billed charges,24% of total billed charges ,154.8,24,,,percent of total billed charges,24% of total billed charges ,6.5,516,
METHADONE SCREEN,4119294,CDM,300,RC,80358,HCPCS,Outpatient,,,821,410.5,,20.53,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,197.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,656.8,80,,,percent of total billed charges,80% of total billed charges ,199.01,24.24,,,percent of total billed charges,24.24% of total billed charges ,413.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,615.75,75,,,percent of total billed charges,75% of total billed charges ,200.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.53,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,197.04,24,,,percent of total billed charges,24% of total billed charges ,256.15,31.2,,,percent of total billed charges,31.2% of total billed charges,656.8,80,,,percent of total billed charges,80% of total billed charges,197.04,24,,,percent of total billed charges,24% of total billed charges ,197.04,24,,,percent of total billed charges,24% of total billed charges ,20.53,656.8,
T3 REVERSE,4119296,CDM,300,RC,84482,HCPCS,Outpatient,,,274,137,,19.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,65.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,219.2,80,,,percent of total billed charges,80% of total billed charges ,66.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,138.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,205.5,75,,,percent of total billed charges,75% of total billed charges ,67.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,65.76,24,,,percent of total billed charges,24% of total billed charges ,85.49,31.2,,,percent of total billed charges,31.2% of total billed charges,219.2,80,,,percent of total billed charges,80% of total billed charges,65.76,24,,,percent of total billed charges,24% of total billed charges ,65.76,24,,,percent of total billed charges,24% of total billed charges ,19.82,219.2,
ETHYL GLUCURONIDE UA,4119297,CDM,301,RC,80321,HCPCS,Outpatient,,,438,219,,13.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,105.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,350.4,80,,,percent of total billed charges,80% of total billed charges ,106.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,220.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,328.5,75,,,percent of total billed charges,75% of total billed charges ,107.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,105.12,24,,,percent of total billed charges,24% of total billed charges ,136.66,31.2,,,percent of total billed charges,31.2% of total billed charges,350.4,80,,,percent of total billed charges,80% of total billed charges,105.12,24,,,percent of total billed charges,24% of total billed charges ,105.12,24,,,percent of total billed charges,24% of total billed charges ,13.59,350.4,
THIOPURINE METHYLTR,4119298,CDM,300,RC,82657,HCPCS,Outpatient,,,766.5,383.25,,7.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,183.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,613.2,80,,,percent of total billed charges,80% of total billed charges ,185.8,24.24,,,percent of total billed charges,24.24% of total billed charges ,386.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,574.88,75,,,percent of total billed charges,75% of total billed charges ,187.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,183.96,24,,,percent of total billed charges,24% of total billed charges ,239.15,31.2,,,percent of total billed charges,31.2% of total billed charges,613.2,80,,,percent of total billed charges,80% of total billed charges,183.96,24,,,percent of total billed charges,24% of total billed charges ,183.96,24,,,percent of total billed charges,24% of total billed charges ,7.55,613.2,
A FLAVIS ALLERGEN,4119299,CDM,300,RC,86003,HCPCS,Outpatient,,,35,17.5,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28,80,,,percent of total billed charges,80% of total billed charges ,8.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.4,24,,,percent of total billed charges,24% of total billed charges ,10.92,31.2,,,percent of total billed charges,31.2% of total billed charges,28,80,,,percent of total billed charges,80% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,6.57,28,
B PERTUSSIS IGG AB,4119300,CDM,300,RC,86615,HCPCS,Outpatient,,,139,69.5,,16.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,111.2,80,,,percent of total billed charges,80% of total billed charges ,33.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,70.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,104.25,75,,,percent of total billed charges,75% of total billed charges ,34.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.36,24,,,percent of total billed charges,24% of total billed charges ,43.37,31.2,,,percent of total billed charges,31.2% of total billed charges,111.2,80,,,percent of total billed charges,80% of total billed charges,33.36,24,,,percent of total billed charges,24% of total billed charges ,33.36,24,,,percent of total billed charges,24% of total billed charges ,16.59,111.2,
AMINOLEVULINIC ACID URINE,4119301,CDM,300,RC,82135,HCPCS,Outpatient,,,217.5,108.75,,20.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,174,80,,,percent of total billed charges,80% of total billed charges ,52.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,109.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,163.13,75,,,percent of total billed charges,75% of total billed charges ,53.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,52.2,24,,,percent of total billed charges,24% of total billed charges ,67.86,31.2,,,percent of total billed charges,31.2% of total billed charges,174,80,,,percent of total billed charges,80% of total billed charges,52.2,24,,,percent of total billed charges,24% of total billed charges ,52.2,24,,,percent of total billed charges,24% of total billed charges ,20.7,174,
DO NOT USE(VIT D),4119302,CDM,300,RC,82306,HCPCS,Outpatient,,,188.5,94.25,,37.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.8,80,,,percent of total billed charges,80% of total billed charges ,45.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,95,50.4,,,percent of total billed charges,50.4% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,46.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.24,24,,,percent of total billed charges,24% of total billed charges ,58.81,31.2,,,percent of total billed charges,31.2% of total billed charges,150.8,80,,,percent of total billed charges,80% of total billed charges,45.24,24,,,percent of total billed charges,24% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,37.22,150.8,
VITAMIN K,4119308,CDM,300,RC,84597,HCPCS,Outpatient,,,312,156,,17.24,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,74.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,249.6,80,,,percent of total billed charges,80% of total billed charges ,75.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,157.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,234,75,,,percent of total billed charges,75% of total billed charges ,76.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.24,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,74.88,24,,,percent of total billed charges,24% of total billed charges ,97.34,31.2,,,percent of total billed charges,31.2% of total billed charges,249.6,80,,,percent of total billed charges,80% of total billed charges,74.88,24,,,percent of total billed charges,24% of total billed charges ,74.88,24,,,percent of total billed charges,24% of total billed charges ,17.24,249.6,
CSF SODIUM,4119309,CDM,300,RC,84302,HCPCS,Outpatient,,,121.5,60.75,,4.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,97.2,80,,,percent of total billed charges,80% of total billed charges ,29.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.16,24,,,percent of total billed charges,24% of total billed charges ,37.91,31.2,,,percent of total billed charges,31.2% of total billed charges,97.2,80,,,percent of total billed charges,80% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,4.35,97.2,
BF CHLORIDE,4119310,CDM,300,RC,82438,HCPCS,Outpatient,,,121.5,60.75,,6.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,97.2,80,,,percent of total billed charges,80% of total billed charges ,29.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.16,24,,,percent of total billed charges,24% of total billed charges ,37.91,31.2,,,percent of total billed charges,31.2% of total billed charges,97.2,80,,,percent of total billed charges,80% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,6.15,97.2,
GC  AMPLIFIED,4119312,CDM,300,RC,87591,HCPCS,Outpatient,,,262.5,131.25,,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,196.88,75,,,percent of total billed charges,75% of total billed charges ,196.88,75,,,percent of total billed charges,75% of total billed charges ,63,24,,,percent of total billed charges,24% of total billed charges ,196.88,75,,,percent of total billed charges,75% of total billed charges ,196.88,75,,,percent of total billed charges,75% of total billed charges ,210,80,,,percent of total billed charges,80% of total billed charges ,63.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,132.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,196.88,75,,,percent of total billed charges,75% of total billed charges ,64.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63,24,,,percent of total billed charges,24% of total billed charges ,81.9,31.2,,,percent of total billed charges,31.2% of total billed charges,210,80,,,percent of total billed charges,80% of total billed charges,63,24,,,percent of total billed charges,24% of total billed charges ,63,24,,,percent of total billed charges,24% of total billed charges ,21.42,210,
CHLAMYDIA  AMPLIFIED,4119313,CDM,300,RC,87491,HCPCS,Outpatient,,,166,83,,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,24.67,132.8,
SEX HORMONE BIND GLOBULIN,4119318,CDM,300,RC,84270,HCPCS,Outpatient,,,87.5,43.75,,27.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,70,80,,,percent of total billed charges,80% of total billed charges ,21.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,44.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,65.63,75,,,percent of total billed charges,75% of total billed charges ,21.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21,24,,,percent of total billed charges,24% of total billed charges ,27.3,31.2,,,percent of total billed charges,31.2% of total billed charges,70,80,,,percent of total billed charges,80% of total billed charges,21,24,,,percent of total billed charges,24% of total billed charges ,21,24,,,percent of total billed charges,24% of total billed charges ,21,70,
PYRUVIC ACID,4119319,CDM,300,RC,84210,HCPCS,Outpatient,,,140,70,,13.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,112,80,,,percent of total billed charges,80% of total billed charges ,33.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,70.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,34.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.6,24,,,percent of total billed charges,24% of total billed charges ,43.68,31.2,,,percent of total billed charges,31.2% of total billed charges,112,80,,,percent of total billed charges,80% of total billed charges,33.6,24,,,percent of total billed charges,24% of total billed charges ,33.6,24,,,percent of total billed charges,24% of total billed charges ,13.65,112,
LACOSAMIDE,4119323,CDM,300,RC,80235,HCPCS,Outpatient,,,141,70.5,,21.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,112.8,80,,,percent of total billed charges,80% of total billed charges ,34.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,71.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,34.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.84,24,,,percent of total billed charges,24% of total billed charges ,43.99,31.2,,,percent of total billed charges,31.2% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,33.84,24,,,percent of total billed charges,24% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,21.69,112.8,
ROCK MT RICKETTSIA IGM,4119324,CDM,300,RC,86757,HCPCS,Outpatient,,,213,106.5,,24.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,159.75,75,,,percent of total billed charges,75% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,24.35,170.4,
BARTONELLA HENSELAE IGM,4119325,CDM,300,RC,86611,HCPCS,Outpatient,,,284.5,142.25,,12.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,12.8,227.6,
EBV CAPSID IGG AB,4119326,CDM,300,RC,86665,HCPCS,Outpatient,,,219.5,109.75,,22.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,175.6,80,,,percent of total billed charges,80% of total billed charges ,53.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,110.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,164.63,75,,,percent of total billed charges,75% of total billed charges ,53.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,52.68,24,,,percent of total billed charges,24% of total billed charges ,68.48,31.2,,,percent of total billed charges,31.2% of total billed charges,175.6,80,,,percent of total billed charges,80% of total billed charges,52.68,24,,,percent of total billed charges,24% of total billed charges ,52.68,24,,,percent of total billed charges,24% of total billed charges ,22.82,175.6,
EBV CAPSID IGM AB,4119327,CDM,300,RC,86665,HCPCS,Outpatient,,,219.5,109.75,,22.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,175.6,80,,,percent of total billed charges,80% of total billed charges ,53.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,110.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,164.63,75,,,percent of total billed charges,75% of total billed charges ,53.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,52.68,24,,,percent of total billed charges,24% of total billed charges ,68.48,31.2,,,percent of total billed charges,31.2% of total billed charges,175.6,80,,,percent of total billed charges,80% of total billed charges,52.68,24,,,percent of total billed charges,24% of total billed charges ,52.68,24,,,percent of total billed charges,24% of total billed charges ,22.82,175.6,
HERPES SIMPLEX C/S AND TYPING,4119328,CDM,300,RC,87273,HCPCS,Outpatient,,,560.5,280.25,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,134.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,448.4,80,,,percent of total billed charges,80% of total billed charges ,135.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,282.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,420.38,75,,,percent of total billed charges,75% of total billed charges ,137.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,134.52,24,,,percent of total billed charges,24% of total billed charges ,174.88,31.2,,,percent of total billed charges,31.2% of total billed charges,448.4,80,,,percent of total billed charges,80% of total billed charges,134.52,24,,,percent of total billed charges,24% of total billed charges ,134.52,24,,,percent of total billed charges,24% of total billed charges ,15.08,448.4,
HSV 2 IGM AB,4119329,CDM,300,RC,86696,HCPCS,Outpatient,,,256.5,128.25,,24.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,205.2,80,,,percent of total billed charges,80% of total billed charges ,62.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,129.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,192.38,75,,,percent of total billed charges,75% of total billed charges ,62.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.56,24,,,percent of total billed charges,24% of total billed charges ,80.03,31.2,,,percent of total billed charges,31.2% of total billed charges,205.2,80,,,percent of total billed charges,80% of total billed charges,61.56,24,,,percent of total billed charges,24% of total billed charges ,61.56,24,,,percent of total billed charges,24% of total billed charges ,24.35,205.2,
HSV 2 IGG AB,4119330,CDM,300,RC,86696,HCPCS,Outpatient,,,256.5,128.25,,24.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,205.2,80,,,percent of total billed charges,80% of total billed charges ,62.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,129.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,192.38,75,,,percent of total billed charges,75% of total billed charges ,62.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.56,24,,,percent of total billed charges,24% of total billed charges ,80.03,31.2,,,percent of total billed charges,31.2% of total billed charges,205.2,80,,,percent of total billed charges,80% of total billed charges,61.56,24,,,percent of total billed charges,24% of total billed charges ,61.56,24,,,percent of total billed charges,24% of total billed charges ,24.35,205.2,
HIV 1 ANTIBODY,4119331,CDM,300,RC,86701,HCPCS,Outpatient,,,161.5,80.75,,9.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,121.13,75,,,percent of total billed charges,75% of total billed charges ,121.13,75,,,percent of total billed charges,75% of total billed charges ,38.76,24,,,percent of total billed charges,24% of total billed charges ,121.13,75,,,percent of total billed charges,75% of total billed charges ,121.13,75,,,percent of total billed charges,75% of total billed charges ,129.2,80,,,percent of total billed charges,80% of total billed charges ,39.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,81.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,121.13,75,,,percent of total billed charges,75% of total billed charges ,39.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,38.76,24,,,percent of total billed charges,24% of total billed charges ,50.39,31.2,,,percent of total billed charges,31.2% of total billed charges,129.2,80,,,percent of total billed charges,80% of total billed charges,38.76,24,,,percent of total billed charges,24% of total billed charges ,38.76,24,,,percent of total billed charges,24% of total billed charges ,9.7,129.2,
HIV 2,4119332,CDM,300,RC,86702,HCPCS,Outpatient,,,161.5,80.75,,14.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,121.13,75,,,percent of total billed charges,75% of total billed charges ,121.13,75,,,percent of total billed charges,75% of total billed charges ,38.76,24,,,percent of total billed charges,24% of total billed charges ,121.13,75,,,percent of total billed charges,75% of total billed charges ,121.13,75,,,percent of total billed charges,75% of total billed charges ,129.2,80,,,percent of total billed charges,80% of total billed charges ,39.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,81.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,121.13,75,,,percent of total billed charges,75% of total billed charges ,39.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,38.76,24,,,percent of total billed charges,24% of total billed charges ,50.39,31.2,,,percent of total billed charges,31.2% of total billed charges,129.2,80,,,percent of total billed charges,80% of total billed charges,38.76,24,,,percent of total billed charges,24% of total billed charges ,38.76,24,,,percent of total billed charges,24% of total billed charges ,14.75,129.2,
HTLV I IGG AB,4119333,CDM,300,RC,86687,HCPCS,Outpatient,,,96,48,,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,76.8,
HTLV 2 IGG AB,4119334,CDM,300,RC,86920,HCPCS,Outpatient,,,96,48,,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,76.8,
BB CROSSMATCH IMMEDIATE SPIN,4119335,CDM,300,RC,86920,HCPCS,Outpatient,,,338,169,,90.79,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,81.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,270.4,80,,,percent of total billed charges,80% of total billed charges ,81.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,170.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,253.5,75,,,percent of total billed charges,75% of total billed charges ,82.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,90.79,26.86,,,percent of total billed charges,26.86% of total billed charges,81.12,24,,,percent of total billed charges,24% of total billed charges ,105.46,31.2,,,percent of total billed charges,31.2% of total billed charges,270.4,80,,,percent of total billed charges,80% of total billed charges,81.12,24,,,percent of total billed charges,24% of total billed charges ,81.12,24,,,percent of total billed charges,24% of total billed charges ,81.12,270.4,
HEPATIC FUNCTION PROFILE,4119336,CDM,301,RC,80076,HCPCS,Outpatient,,,249.5,124.75,,10.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,59.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,199.6,80,,,percent of total billed charges,80% of total billed charges ,60.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,125.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,187.13,75,,,percent of total billed charges,75% of total billed charges ,61.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,59.88,24,,,percent of total billed charges,24% of total billed charges ,77.84,31.2,,,percent of total billed charges,31.2% of total billed charges,199.6,80,,,percent of total billed charges,80% of total billed charges,59.88,24,,,percent of total billed charges,24% of total billed charges ,59.88,24,,,percent of total billed charges,24% of total billed charges ,10.28,199.6,
URINE PROTEIN TEST STRIP,4119337,CDM,300,RC,81001,HCPCS,Outpatient,,,75,37.5,,3.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.25,75,,,percent of total billed charges,75% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,18,24,,,percent of total billed charges,24% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,60,80,,,percent of total billed charges,80% of total billed charges ,18.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,18.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18,24,,,percent of total billed charges,24% of total billed charges ,23.4,31.2,,,percent of total billed charges,31.2% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,18,24,,,percent of total billed charges,24% of total billed charges ,18,24,,,percent of total billed charges,24% of total billed charges ,3.99,60,
PROTEIN C AG TOTAL,4119338,CDM,300,RC,85302,HCPCS,Outpatient,,,96,48,,15.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,15.12,76.8,
PROTEIN S AG TOTAL,4119339,CDM,300,RC,85305,HCPCS,Outpatient,,,100,50,,14.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80,80,,,percent of total billed charges,80% of total billed charges ,24.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,75,75,,,percent of total billed charges,75% of total billed charges ,24.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24,24,,,percent of total billed charges,24% of total billed charges ,31.2,31.2,,,percent of total billed charges,31.2% of total billed charges,80,80,,,percent of total billed charges,80% of total billed charges,24,24,,,percent of total billed charges,24% of total billed charges ,24,24,,,percent of total billed charges,24% of total billed charges ,14.58,80,
HERPES CULTURE,4119340,CDM,300,RC,87255,HCPCS,Outpatient,,,145,72.5,,38.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,116,80,,,percent of total billed charges,80% of total billed charges ,35.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,73.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,108.75,75,,,percent of total billed charges,75% of total billed charges ,35.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,38.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.8,24,,,percent of total billed charges,24% of total billed charges ,45.24,31.2,,,percent of total billed charges,31.2% of total billed charges,116,80,,,percent of total billed charges,80% of total billed charges,34.8,24,,,percent of total billed charges,24% of total billed charges ,34.8,24,,,percent of total billed charges,24% of total billed charges ,34.8,116,
HSV 1 CULTURE,4119341,CDM,300,RC,87274,HCPCS,Outpatient,,,73,36.5,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,15.08,58.4,
HSV 2 CULTURE,4119342,CDM,300,RC,87273,HCPCS,Outpatient,,,73,36.5,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,15.08,58.4,
SELENIUM,4119345,CDM,301,RC,84255,HCPCS,Outpatient,,,110,55,,32.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,88,
H PYLORI AG STOOL,4119346,CDM,300,RC,87338,HCPCS,Outpatient,,,133,66.5,,18.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,106.4,80,,,percent of total billed charges,80% of total billed charges ,32.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,67.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,32.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.92,24,,,percent of total billed charges,24% of total billed charges ,41.5,31.2,,,percent of total billed charges,31.2% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,31.92,24,,,percent of total billed charges,24% of total billed charges ,31.92,24,,,percent of total billed charges,24% of total billed charges ,18.09,106.4,
ANAEROBIC CULTURE w/ GRAM STAIN,4119347,CDM,300,RC,87075,HCPCS,Outpatient,,,166,83,,11.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,11.9,132.8,
EAR CULTURE,4119348,CDM,300,RC,87070,HCPCS,Outpatient,,,167,83.5,,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,133.6,80,,,percent of total billed charges,80% of total billed charges ,40.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,84.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,125.25,75,,,percent of total billed charges,75% of total billed charges ,40.88,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.08,24,,,percent of total billed charges,24% of total billed charges ,52.1,31.2,,,percent of total billed charges,31.2% of total billed charges,133.6,80,,,percent of total billed charges,80% of total billed charges,40.08,24,,,percent of total billed charges,24% of total billed charges ,40.08,24,,,percent of total billed charges,24% of total billed charges ,10.83,133.6,
EYE CULTURE,4119349,CDM,300,RC,87070,HCPCS,Outpatient,,,167,83.5,,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,133.6,80,,,percent of total billed charges,80% of total billed charges ,40.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,84.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,125.25,75,,,percent of total billed charges,75% of total billed charges ,40.88,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.08,24,,,percent of total billed charges,24% of total billed charges ,52.1,31.2,,,percent of total billed charges,31.2% of total billed charges,133.6,80,,,percent of total billed charges,80% of total billed charges,40.08,24,,,percent of total billed charges,24% of total billed charges ,40.08,24,,,percent of total billed charges,24% of total billed charges ,10.83,133.6,
"MRSA SCREEN, NASAL",4119350,CDM,300,RC,87070,HCPCS,Outpatient,,,167,83.5,,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,133.6,80,,,percent of total billed charges,80% of total billed charges ,40.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,84.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,125.25,75,,,percent of total billed charges,75% of total billed charges ,40.88,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.08,24,,,percent of total billed charges,24% of total billed charges ,52.1,31.2,,,percent of total billed charges,31.2% of total billed charges,133.6,80,,,percent of total billed charges,80% of total billed charges,40.08,24,,,percent of total billed charges,24% of total billed charges ,40.08,24,,,percent of total billed charges,24% of total billed charges ,10.83,133.6,
SPUTUM CULTURE,4119351,CDM,300,RC,87070,HCPCS,Outpatient,,,167,83.5,,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,133.6,80,,,percent of total billed charges,80% of total billed charges ,40.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,84.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,125.25,75,,,percent of total billed charges,75% of total billed charges ,40.88,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.08,24,,,percent of total billed charges,24% of total billed charges ,52.1,31.2,,,percent of total billed charges,31.2% of total billed charges,133.6,80,,,percent of total billed charges,80% of total billed charges,40.08,24,,,percent of total billed charges,24% of total billed charges ,40.08,24,,,percent of total billed charges,24% of total billed charges ,10.83,133.6,
"STREP PNEU AG, URINE",4119353,CDM,300,RC,87899,HCPCS,Outpatient,,,281,140.5,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,210.75,75,,,percent of total billed charges,75% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,67.44,24,,,percent of total billed charges,24% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,224.8,80,,,percent of total billed charges,80% of total billed charges ,68.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,141.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,68.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,67.44,24,,,percent of total billed charges,24% of total billed charges ,87.67,31.2,,,percent of total billed charges,31.2% of total billed charges,224.8,80,,,percent of total billed charges,80% of total billed charges,67.44,24,,,percent of total billed charges,24% of total billed charges ,67.44,24,,,percent of total billed charges,24% of total billed charges ,15.08,224.8,
VON WILL FACT AG,4119354,CDM,300,RC,85246,HCPCS,Outpatient,,,465.5,232.75,,28.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,111.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,372.4,80,,,percent of total billed charges,80% of total billed charges ,112.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,234.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,349.13,75,,,percent of total billed charges,75% of total billed charges ,113.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,111.72,24,,,percent of total billed charges,24% of total billed charges ,145.24,31.2,,,percent of total billed charges,31.2% of total billed charges,372.4,80,,,percent of total billed charges,80% of total billed charges,111.72,24,,,percent of total billed charges,24% of total billed charges ,111.72,24,,,percent of total billed charges,24% of total billed charges ,28.85,372.4,
VON WILL FACT ACT,4119355,CDM,300,RC,85245,HCPCS,Outpatient,,,465.5,232.75,,28.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,111.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,372.4,80,,,percent of total billed charges,80% of total billed charges ,112.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,234.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,349.13,75,,,percent of total billed charges,75% of total billed charges ,113.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,111.72,24,,,percent of total billed charges,24% of total billed charges ,145.24,31.2,,,percent of total billed charges,31.2% of total billed charges,372.4,80,,,percent of total billed charges,80% of total billed charges,111.72,24,,,percent of total billed charges,24% of total billed charges ,111.72,24,,,percent of total billed charges,24% of total billed charges ,28.85,372.4,
GLOMERULAR FILTRATION RATE/1 73 SQ M PRE,4119357,CDM,301,RC,82565,HCPCS,Outpatient,,,,,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.35,6.35,
HEPATITIS BE ANTIBODY,4119359,CDM,300,RC,86707,HCPCS,Outpatient,,,146.5,73.25,,14.54,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,109.88,75,,,percent of total billed charges,75% of total billed charges ,109.88,75,,,percent of total billed charges,75% of total billed charges ,35.16,24,,,percent of total billed charges,24% of total billed charges ,109.88,75,,,percent of total billed charges,75% of total billed charges ,109.88,75,,,percent of total billed charges,75% of total billed charges ,117.2,80,,,percent of total billed charges,80% of total billed charges ,35.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,73.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,109.88,75,,,percent of total billed charges,75% of total billed charges ,35.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.54,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,35.16,24,,,percent of total billed charges,24% of total billed charges ,45.71,31.2,,,percent of total billed charges,31.2% of total billed charges,117.2,80,,,percent of total billed charges,80% of total billed charges,35.16,24,,,percent of total billed charges,24% of total billed charges ,35.16,24,,,percent of total billed charges,24% of total billed charges ,14.54,117.2,
CYTO FLUIDS WASHINGS-88104,4119360,CDM,311,RC,88104,HCPCS,Outpatient,,,51.5,25.75,,42.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,42.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,42.68,
CYTO CONC SMEARS INTER,4119361,CDM,310,RC,88108,HCPCS,Outpatient,,,51.5,25.75,,45.74,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,45.74,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,45.74,
FNA INTERPRETATION AND REPORT,4119362,CDM,311,RC,88173,HCPCS,Outpatient,,,112.5,56.25,,91.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,90,80,,,percent of total billed charges,80% of total billed charges ,27.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,56.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,27.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,91.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27,24,,,percent of total billed charges,24% of total billed charges ,35.1,31.2,,,percent of total billed charges,31.2% of total billed charges,90,80,,,percent of total billed charges,80% of total billed charges,27,24,,,percent of total billed charges,24% of total billed charges ,27,24,,,percent of total billed charges,24% of total billed charges ,27,91.58,
PATH LEVEL 1 SURG 88300,4119363,CDM,310,RC,88300,HCPCS,Outpatient,,,204,102,,14.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,163.2,80,,,percent of total billed charges,80% of total billed charges ,49.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,102.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,153,75,,,percent of total billed charges,75% of total billed charges ,49.94,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,48.96,24,,,percent of total billed charges,24% of total billed charges ,63.65,31.2,,,percent of total billed charges,31.2% of total billed charges,163.2,80,,,percent of total billed charges,80% of total billed charges,48.96,24,,,percent of total billed charges,24% of total billed charges ,48.96,24,,,percent of total billed charges,24% of total billed charges ,14.3,163.2,
PATH LEVEL II SURG  - 88302,4119364,CDM,310,RC,88302,HCPCS,Outpatient,,,409,204.5,,35.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,98.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,327.2,80,,,percent of total billed charges,80% of total billed charges ,99.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,306.75,75,,,percent of total billed charges,75% of total billed charges ,100.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,98.16,24,,,percent of total billed charges,24% of total billed charges ,127.61,31.2,,,percent of total billed charges,31.2% of total billed charges,327.2,80,,,percent of total billed charges,80% of total billed charges,98.16,24,,,percent of total billed charges,24% of total billed charges ,98.16,24,,,percent of total billed charges,24% of total billed charges ,35.06,327.2,
PATH LEVEL III SURG - 88304,4119365,CDM,310,RC,88304,HCPCS,Outpatient,,,419,209.5,,30.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,100.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,335.2,80,,,percent of total billed charges,80% of total billed charges ,101.57,24.24,,,percent of total billed charges,24.24% of total billed charges ,211.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,314.25,75,,,percent of total billed charges,75% of total billed charges ,102.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,100.56,24,,,percent of total billed charges,24% of total billed charges ,130.73,31.2,,,percent of total billed charges,31.2% of total billed charges,335.2,80,,,percent of total billed charges,80% of total billed charges,100.56,24,,,percent of total billed charges,24% of total billed charges ,100.56,24,,,percent of total billed charges,24% of total billed charges ,30.18,335.2,
PATH LEVEL IV SURG  - 88305,4119366,CDM,310,RC,88305,HCPCS,Outpatient,,,503.5,251.75,,65.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,120.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,402.8,80,,,percent of total billed charges,80% of total billed charges ,122.05,24.24,,,percent of total billed charges,24.24% of total billed charges ,253.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,377.63,75,,,percent of total billed charges,75% of total billed charges ,123.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,65.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,120.84,24,,,percent of total billed charges,24% of total billed charges ,157.09,31.2,,,percent of total billed charges,31.2% of total billed charges,402.8,80,,,percent of total billed charges,80% of total billed charges,120.84,24,,,percent of total billed charges,24% of total billed charges ,120.84,24,,,percent of total billed charges,24% of total billed charges ,65.88,402.8,
PATH LEVEL V SURG  - 88307,4119367,CDM,310,RC,88307,HCPCS,Outpatient,,,721,360.5,,133.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,173.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,576.8,80,,,percent of total billed charges,80% of total billed charges ,174.77,24.24,,,percent of total billed charges,24.24% of total billed charges ,363.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,540.75,75,,,percent of total billed charges,75% of total billed charges ,176.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,133.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,173.04,24,,,percent of total billed charges,24% of total billed charges ,224.95,31.2,,,percent of total billed charges,31.2% of total billed charges,576.8,80,,,percent of total billed charges,80% of total billed charges,173.04,24,,,percent of total billed charges,24% of total billed charges ,173.04,24,,,percent of total billed charges,24% of total billed charges ,133.3,576.8,
PATH LEVEL VI SURG  - 88309,4119368,CDM,310,RC,88309,HCPCS,Outpatient,,,1564.5,782.25,,187.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,375.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1251.6,80,,,percent of total billed charges,80% of total billed charges ,379.23,24.24,,,percent of total billed charges,24.24% of total billed charges ,788.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,1173.38,75,,,percent of total billed charges,75% of total billed charges ,382.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,187.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,375.48,24,,,percent of total billed charges,24% of total billed charges ,488.12,31.2,,,percent of total billed charges,31.2% of total billed charges,1251.6,80,,,percent of total billed charges,80% of total billed charges,375.48,24,,,percent of total billed charges,24% of total billed charges ,375.48,24,,,percent of total billed charges,24% of total billed charges ,187.78,1251.6,
PATH DECALCIFICATION - 88311,4119369,CDM,312,RC,88311,HCPCS,Outpatient,,,34,17,,15.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
PATH SPECIAL STAINS GROUP 1 -88312,4119370,CDM,312,RC,88312,HCPCS,Outpatient,,,432.5,216.25,,43.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,103.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,346,80,,,percent of total billed charges,80% of total billed charges ,104.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,217.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,324.38,75,,,percent of total billed charges,75% of total billed charges ,105.88,24.48,,,percent of total billed charges,24.48% of total billed charges ,43.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,103.8,24,,,percent of total billed charges,24% of total billed charges ,134.94,31.2,,,percent of total billed charges,31.2% of total billed charges,346,80,,,percent of total billed charges,80% of total billed charges,103.8,24,,,percent of total billed charges,24% of total billed charges ,103.8,24,,,percent of total billed charges,24% of total billed charges ,43.39,346,
PATH SPECIAL STAINS GROUP 2 - 88313,4119371,CDM,312,RC,88313,HCPCS,Outpatient,,,434.5,217.25,,44.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,104.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,347.6,80,,,percent of total billed charges,80% of total billed charges ,105.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,218.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,325.88,75,,,percent of total billed charges,75% of total billed charges ,106.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,44.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,104.28,24,,,percent of total billed charges,24% of total billed charges ,135.56,31.2,,,percent of total billed charges,31.2% of total billed charges,347.6,80,,,percent of total billed charges,80% of total billed charges,104.28,24,,,percent of total billed charges,24% of total billed charges ,104.28,24,,,percent of total billed charges,24% of total billed charges ,44.91,347.6,
PATH IMMUNO HISTOCHEMISTRY 88342,4119372,CDM,312,RC,88342,HCPCS,Outpatient,,,281,140.5,,71.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,67.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,224.8,80,,,percent of total billed charges,80% of total billed charges ,68.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,141.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,210.75,75,,,percent of total billed charges,75% of total billed charges ,68.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,71.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,67.44,24,,,percent of total billed charges,24% of total billed charges ,87.67,31.2,,,percent of total billed charges,31.2% of total billed charges,224.8,80,,,percent of total billed charges,80% of total billed charges,67.44,24,,,percent of total billed charges,24% of total billed charges ,67.44,24,,,percent of total billed charges,24% of total billed charges ,67.44,224.8,
URINE 24 HR OXALATE,4119373,CDM,300,RC,83945,HCPCS,Outpatient,,,55.5,27.75,,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,44.4,80,,,percent of total billed charges,80% of total billed charges ,13.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,27.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,13.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.32,24,,,percent of total billed charges,24% of total billed charges ,17.32,31.2,,,percent of total billed charges,31.2% of total billed charges,44.4,80,,,percent of total billed charges,80% of total billed charges,13.32,24,,,percent of total billed charges,24% of total billed charges ,13.32,24,,,percent of total billed charges,24% of total billed charges ,13.32,44.4,
URINE 24 HR SULFATE,4119374,CDM,300,RC,84392,HCPCS,Outpatient,,,68,34,,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.4,80,,,percent of total billed charges,80% of total billed charges ,16.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,16.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.32,24,,,percent of total billed charges,24% of total billed charges ,21.22,31.2,,,percent of total billed charges,31.2% of total billed charges,54.4,80,,,percent of total billed charges,80% of total billed charges,16.32,24,,,percent of total billed charges,24% of total billed charges ,16.32,24,,,percent of total billed charges,24% of total billed charges ,5.98,54.4,
E COLI SHIGA TOXIN,4119375,CDM,300,RC,87427,HCPCS,Outpatient,,,125.5,62.75,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,94.13,75,,,percent of total billed charges,75% of total billed charges ,94.13,75,,,percent of total billed charges,75% of total billed charges ,30.12,24,,,percent of total billed charges,24% of total billed charges ,94.13,75,,,percent of total billed charges,75% of total billed charges ,94.13,75,,,percent of total billed charges,75% of total billed charges ,100.4,80,,,percent of total billed charges,80% of total billed charges ,30.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,63.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,94.13,75,,,percent of total billed charges,75% of total billed charges ,30.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,30.12,24,,,percent of total billed charges,24% of total billed charges ,39.16,31.2,,,percent of total billed charges,31.2% of total billed charges,100.4,80,,,percent of total billed charges,80% of total billed charges,30.12,24,,,percent of total billed charges,24% of total billed charges ,30.12,24,,,percent of total billed charges,24% of total billed charges ,15.08,100.4,
E COLI SHIGA TOXIN 2,4119376,CDM,300,RC,87427,HCPCS,Outpatient,,,125.5,62.75,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,94.13,75,,,percent of total billed charges,75% of total billed charges ,94.13,75,,,percent of total billed charges,75% of total billed charges ,30.12,24,,,percent of total billed charges,24% of total billed charges ,94.13,75,,,percent of total billed charges,75% of total billed charges ,94.13,75,,,percent of total billed charges,75% of total billed charges ,100.4,80,,,percent of total billed charges,80% of total billed charges ,30.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,63.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,94.13,75,,,percent of total billed charges,75% of total billed charges ,30.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,30.12,24,,,percent of total billed charges,24% of total billed charges ,39.16,31.2,,,percent of total billed charges,31.2% of total billed charges,100.4,80,,,percent of total billed charges,80% of total billed charges,30.12,24,,,percent of total billed charges,24% of total billed charges ,30.12,24,,,percent of total billed charges,24% of total billed charges ,15.08,100.4,
CAMPYLOBACTER AG,4119377,CDM,300,RC,87449,HCPCS,Outpatient,,,63,31.5,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.08,50.4,
PORPHOBILINOGEN URINE,4119378,CDM,300,RC,84110,HCPCS,Outpatient,,,105,52.5,,10.62,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,84,80,,,percent of total billed charges,80% of total billed charges ,25.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.75,75,,,percent of total billed charges,75% of total billed charges ,25.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.62,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.2,24,,,percent of total billed charges,24% of total billed charges ,32.76,31.2,,,percent of total billed charges,31.2% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,25.2,24,,,percent of total billed charges,24% of total billed charges ,25.2,24,,,percent of total billed charges,24% of total billed charges ,10.62,84,
COMPLEMENT C2,4119379,CDM,300,RC,86160,HCPCS,Outpatient,,,76,38,,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60.8,80,,,percent of total billed charges,80% of total billed charges ,18.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,38.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,57,75,,,percent of total billed charges,75% of total billed charges ,18.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.24,24,,,percent of total billed charges,24% of total billed charges ,23.71,31.2,,,percent of total billed charges,31.2% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,18.24,24,,,percent of total billed charges,24% of total billed charges ,18.24,24,,,percent of total billed charges,24% of total billed charges ,15.1,60.8,
SACCHAROMYCES IGA,4119380,CDM,300,RC,86671,HCPCS,Outpatient,,,104,52,,15.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,83.2,80,,,percent of total billed charges,80% of total billed charges ,25.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,25.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.96,24,,,percent of total billed charges,24% of total billed charges ,32.45,31.2,,,percent of total billed charges,31.2% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,15.42,83.2,
SACCHAROMYCES IGG,4119381,CDM,300,RC,86671,HCPCS,Outpatient,,,504,252,,15.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,120.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,403.2,80,,,percent of total billed charges,80% of total billed charges ,122.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,254.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,378,75,,,percent of total billed charges,75% of total billed charges ,123.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,120.96,24,,,percent of total billed charges,24% of total billed charges ,157.25,31.2,,,percent of total billed charges,31.2% of total billed charges,403.2,80,,,percent of total billed charges,80% of total billed charges,120.96,24,,,percent of total billed charges,24% of total billed charges ,120.96,24,,,percent of total billed charges,24% of total billed charges ,15.42,403.2,
ANCA  ATYPICAL,4119382,CDM,300,RC,86255,HCPCS,Outpatient,,,104,52,,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,83.2,80,,,percent of total billed charges,80% of total billed charges ,25.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,25.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.96,24,,,percent of total billed charges,24% of total billed charges ,32.45,31.2,,,percent of total billed charges,31.2% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,15.16,83.2,
"BETA HCG, QUANT",4119383,CDM,300,RC,84702,HCPCS,Outpatient,,,122.5,61.25,,8.07,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,98,80,,,percent of total billed charges,80% of total billed charges ,29.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.07,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.4,24,,,percent of total billed charges,24% of total billed charges ,38.22,31.2,,,percent of total billed charges,31.2% of total billed charges,98,80,,,percent of total billed charges,80% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,8.07,98,
CULTURE WOUND  AEROBIC,4119385,CDM,300,RC,87070,HCPCS,Outpatient,,,199,99.5,,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,10.83,159.2,
TOTAL PROTEIN 24 HOUR URINE,4119386,CDM,300,RC,84156,HCPCS,Outpatient,,,108,54,,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,4.61,86.4,
CHOLINESTERASE,4119387,CDM,300,RC,82480,HCPCS,Outpatient,,,166,83,,9.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,9.91,132.8,
HEP BE AG,4119388,CDM,300,RC,87350,HCPCS,Outpatient,,,199,99.5,,14.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,14.49,159.2,
VITAMIN E,4119389,CDM,300,RC,84446,HCPCS,Outpatient,,,119.5,59.75,,17.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,17.83,95.6,
VITAMIN E GAMMA,4119390,CDM,301,RC,84591,HCPCS,Outpatient,,,178,89,,14.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,14.58,142.4,
UDS CONFIRMATION,4119391,CDM,300,RC,80375,HCPCS,Outpatient,,,488,244,,18.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,117.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,390.4,80,,,percent of total billed charges,80% of total billed charges ,118.29,24.24,,,percent of total billed charges,24.24% of total billed charges ,245.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,366,75,,,percent of total billed charges,75% of total billed charges ,119.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,117.12,24,,,percent of total billed charges,24% of total billed charges ,152.26,31.2,,,percent of total billed charges,31.2% of total billed charges,390.4,80,,,percent of total billed charges,80% of total billed charges,117.12,24,,,percent of total billed charges,24% of total billed charges ,117.12,24,,,percent of total billed charges,24% of total billed charges ,18.25,390.4,
URINE CYTOLOGY EXAM,4119392,CDM,311,RC,88104,HCPCS,Outpatient,,,147.5,73.75,,42.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,118,80,,,percent of total billed charges,80% of total billed charges ,35.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,74.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,110.63,75,,,percent of total billed charges,75% of total billed charges ,36.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,42.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,35.4,24,,,percent of total billed charges,24% of total billed charges ,46.02,31.2,,,percent of total billed charges,31.2% of total billed charges,118,80,,,percent of total billed charges,80% of total billed charges,35.4,24,,,percent of total billed charges,24% of total billed charges ,35.4,24,,,percent of total billed charges,24% of total billed charges ,35.4,118,
BF CYTOLOGY,4119393,CDM,311,RC,88112,HCPCS,Outpatient,,,419,209.5,,106.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,100.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,335.2,80,,,percent of total billed charges,80% of total billed charges ,101.57,24.24,,,percent of total billed charges,24.24% of total billed charges ,211.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,314.25,75,,,percent of total billed charges,75% of total billed charges ,102.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,106.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,100.56,24,,,percent of total billed charges,24% of total billed charges ,130.73,31.2,,,percent of total billed charges,31.2% of total billed charges,335.2,80,,,percent of total billed charges,80% of total billed charges,100.56,24,,,percent of total billed charges,24% of total billed charges ,100.56,24,,,percent of total billed charges,24% of total billed charges ,100.56,335.2,
SYNOVIAL FLUID MUCIN CLOT,4119394,CDM,300,RC,83872,HCPCS,Outpatient,,,76,38,,12.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60.8,80,,,percent of total billed charges,80% of total billed charges ,18.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,38.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,57,75,,,percent of total billed charges,75% of total billed charges ,18.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.24,24,,,percent of total billed charges,24% of total billed charges ,23.71,31.2,,,percent of total billed charges,31.2% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,18.24,24,,,percent of total billed charges,24% of total billed charges ,18.24,24,,,percent of total billed charges,24% of total billed charges ,12.38,60.8,
ZZZFINGERSTICK GLUCOSE,4119395,CDM,300,RC,82947,HCPCS,Outpatient,,,64,32,,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,4.93,51.2,
PSA SCREEN (CCH),4119396,CDM,300,RC,G0103,HCPCS,Outpatient,,,214,107,,25.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,160.5,75,,,percent of total billed charges,75% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,51.36,24,,,percent of total billed charges,24% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,171.2,80,,,percent of total billed charges,80% of total billed charges ,51.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,52.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.36,24,,,percent of total billed charges,24% of total billed charges ,66.77,31.2,,,percent of total billed charges,31.2% of total billed charges,171.2,80,,,percent of total billed charges,80% of total billed charges,51.36,24,,,percent of total billed charges,24% of total billed charges ,51.36,24,,,percent of total billed charges,24% of total billed charges ,25.7,171.2,
BB RBC AG OTHER THAN ABO OR D EACH,4119397,CDM,300,RC,86905,HCPCS,Outpatient,,,69,34.5,,4.81,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.2,80,,,percent of total billed charges,80% of total billed charges ,16.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.81,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.56,24,,,percent of total billed charges,24% of total billed charges ,21.53,31.2,,,percent of total billed charges,31.2% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,4.81,55.2,
BB RH PHENOTYPING COMPLETE,4119398,CDM,300,RC,86906,HCPCS,Outpatient,,,64,32,,9.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,9.75,51.2,
BB PRE TREATMENT WITH ENZYMES PER CELL,4119399,CDM,300,RC,86971,HCPCS,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
DIFFERENTIAL / ADSORPTION OF SERUM,4119400,CDM,300,RC,86978,HCPCS,Outpatient,,,111,55.5,,29.81,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,88.8,80,,,percent of total billed charges,80% of total billed charges ,26.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,83.25,75,,,percent of total billed charges,75% of total billed charges ,27.17,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.81,26.86,,,percent of total billed charges,26.86% of total billed charges,26.64,24,,,percent of total billed charges,24% of total billed charges ,34.63,31.2,,,percent of total billed charges,31.2% of total billed charges,88.8,80,,,percent of total billed charges,80% of total billed charges,26.64,24,,,percent of total billed charges,24% of total billed charges ,26.64,24,,,percent of total billed charges,24% of total billed charges ,26.64,88.8,
BLOOD SUGAR LEVEL,4119402,CDM,300,RC,82947,HCPCS,Outpatient,,,53.5,26.75,,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.8,80,,,percent of total billed charges,80% of total billed charges ,12.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,13.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.84,24,,,percent of total billed charges,24% of total billed charges ,16.69,31.2,,,percent of total billed charges,31.2% of total billed charges,42.8,80,,,percent of total billed charges,80% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,4.93,42.8,
AMERICAN HOUSE DUST MITE IGE AB,4119403,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
DOG DANDER IGE AB RAST,4119404,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
CAT DANDER IGE AB,4119405,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
COMMON RAGWEED IGE AB RAST,4119406,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
BAHIA GRASS IGE AB,4119407,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
ALTERNARIA ALTERNATA IGE AB,4119408,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
WHITE OAK IGE AB,4119409,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
CODFISH IGE AB RAST,4119410,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
SHRIMP IGE AB,4119411,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
CRAB IGE AB RAST,4119412,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
TUNA IGE RAST,4119413,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
LOBSTER IGE AB RAST,4119414,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
VP CANDIDA SP DNA,4119415,CDM,300,RC,87480,HCPCS,Outpatient,,,108,54,,24.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,81,75,,,percent of total billed charges,75% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,24.8,86.4,
VP GARDERELLA VAG DNA,4119416,CDM,300,RC,87550,HCPCS,Outpatient,,,107,53.5,,28.74,26.86,,,percent of total billed charges,26.86% of total billed charges,80.25,75,,,percent of total billed charges,75% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,25.68,24,,,percent of total billed charges,24% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,85.6,80,,,percent of total billed charges,80% of total billed charges ,25.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,53.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,26.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.74,26.86,,,percent of total billed charges,26.86% of total billed charges,25.68,24,,,percent of total billed charges,24% of total billed charges ,33.38,31.2,,,percent of total billed charges,31.2% of total billed charges,85.6,80,,,percent of total billed charges,80% of total billed charges,25.68,24,,,percent of total billed charges,24% of total billed charges ,25.68,24,,,percent of total billed charges,24% of total billed charges ,25.68,85.6,
VP TRICHOMONAS VAG DNA,4119417,CDM,300,RC,87660,HCPCS,Outpatient,,,108,54,,24.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,24.8,86.4,
PARASITES ID IN TISSUE,4119418,CDM,300,RC,87220,HCPCS,Outpatient,,,27,13.5,,5.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,5.36,21.6,
LEGIONELLA PNEUMO AG URINE,4119419,CDM,300,RC,87449,HCPCS,Outpatient,,,212,106,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,159,75,,,percent of total billed charges,75% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,50.88,24,,,percent of total billed charges,24% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,169.6,80,,,percent of total billed charges,80% of total billed charges ,51.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,106.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,51.9,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,50.88,24,,,percent of total billed charges,24% of total billed charges ,66.14,31.2,,,percent of total billed charges,31.2% of total billed charges,169.6,80,,,percent of total billed charges,80% of total billed charges,50.88,24,,,percent of total billed charges,24% of total billed charges ,50.88,24,,,percent of total billed charges,24% of total billed charges ,15.08,169.6,
SPECIMEN COLLECT QUEST COMMERCIAL BILLIN,4119420,CDM,300,RC,,,Outpatient,,,10.5,5.25,,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,8.4,80,,,percent of total billed charges,80% of total billed charges ,2.55,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,3.28,31.2,,,percent of total billed charges,31.2% of total billed charges,8.4,80,,,percent of total billed charges,80% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,8.4,
"URIC ACID, SYNOVIAL FLUID",4119421,CDM,300,RC,84560,HCPCS,Outpatient,,,50.5,25.25,,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40.4,80,,,percent of total billed charges,80% of total billed charges ,12.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,12.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.12,24,,,percent of total billed charges,24% of total billed charges ,15.76,31.2,,,percent of total billed charges,31.2% of total billed charges,40.4,80,,,percent of total billed charges,80% of total billed charges,12.12,24,,,percent of total billed charges,24% of total billed charges ,12.12,24,,,percent of total billed charges,24% of total billed charges ,5.98,40.4,
INSULIN LEVEL,4119422,CDM,300,RC,83525,HCPCS,Outpatient,,,180.5,90.25,,14.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,43.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,144.4,80,,,percent of total billed charges,80% of total billed charges ,43.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,90.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,44.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,43.32,24,,,percent of total billed charges,24% of total billed charges ,56.32,31.2,,,percent of total billed charges,31.2% of total billed charges,144.4,80,,,percent of total billed charges,80% of total billed charges,43.32,24,,,percent of total billed charges,24% of total billed charges ,43.32,24,,,percent of total billed charges,24% of total billed charges ,14.38,144.4,
CYTO FLUIDS OTHER WASHINGS WITH CENTRIFU,4119423,CDM,310,RC,88108,HCPCS,Outpatient,,,159.5,79.75,,45.74,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,127.6,80,,,percent of total billed charges,80% of total billed charges ,38.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,80.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,39.05,24.48,,,percent of total billed charges,24.48% of total billed charges ,45.74,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,38.28,24,,,percent of total billed charges,24% of total billed charges ,49.76,31.2,,,percent of total billed charges,31.2% of total billed charges,127.6,80,,,percent of total billed charges,80% of total billed charges,38.28,24,,,percent of total billed charges,24% of total billed charges ,38.28,24,,,percent of total billed charges,24% of total billed charges ,38.28,127.6,
CMV IGM AB,4119424,CDM,300,RC,86645,HCPCS,Outpatient,,,143,71.5,,21.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,114.4,80,,,percent of total billed charges,80% of total billed charges ,34.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,35.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.32,24,,,percent of total billed charges,24% of total billed charges ,44.62,31.2,,,percent of total billed charges,31.2% of total billed charges,114.4,80,,,percent of total billed charges,80% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,21.19,114.4,
HEPARIN INDUCED THROMBOCYTOPENIA AB,4119425,CDM,300,RC,86022,HCPCS,Outpatient,,,330.5,165.25,,23.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,79.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,264.4,80,,,percent of total billed charges,80% of total billed charges ,80.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,166.57,50.4,,,percent of total billed charges,50.4% of total billed charges ,247.88,75,,,percent of total billed charges,75% of total billed charges ,80.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,79.32,24,,,percent of total billed charges,24% of total billed charges ,103.12,31.2,,,percent of total billed charges,31.2% of total billed charges,264.4,80,,,percent of total billed charges,80% of total billed charges,79.32,24,,,percent of total billed charges,24% of total billed charges ,79.32,24,,,percent of total billed charges,24% of total billed charges ,23.09,264.4,
CYTOLOGY FNA NON GYN,4119426,CDM,311,RC,88173,HCPCS,Outpatient,,,515,257.5,,91.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,123.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,412,80,,,percent of total billed charges,80% of total billed charges ,124.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,259.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,386.25,75,,,percent of total billed charges,75% of total billed charges ,126.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,91.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,123.6,24,,,percent of total billed charges,24% of total billed charges ,160.68,31.2,,,percent of total billed charges,31.2% of total billed charges,412,80,,,percent of total billed charges,80% of total billed charges,123.6,24,,,percent of total billed charges,24% of total billed charges ,123.6,24,,,percent of total billed charges,24% of total billed charges ,91.58,412,
ETHOSUXIMIDE,4119427,CDM,300,RC,80168,HCPCS,Outpatient,,,69,34.5,,20.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.2,80,,,percent of total billed charges,80% of total billed charges ,16.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.56,24,,,percent of total billed charges,24% of total billed charges ,21.53,31.2,,,percent of total billed charges,31.2% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,55.2,
RBC PORPHOBILINOGEN,4119428,CDM,300,RC,82657,HCPCS,Outpatient,,,101,50.5,,7.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,7.55,80.8,
RBC PORPHYRINS,4119429,CDM,300,RC,84202,HCPCS,Outpatient,,,93.5,46.75,,18.05,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,74.8,80,,,percent of total billed charges,80% of total billed charges ,22.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.05,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.44,24,,,percent of total billed charges,24% of total billed charges ,29.17,31.2,,,percent of total billed charges,31.2% of total billed charges,74.8,80,,,percent of total billed charges,80% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,18.05,74.8,
PORPHYRINS FECES,4119430,CDM,300,RC,84126,HCPCS,Outpatient,,,93.5,46.75,,32.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,74.8,80,,,percent of total billed charges,80% of total billed charges ,22.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.44,24,,,percent of total billed charges,24% of total billed charges ,29.17,31.2,,,percent of total billed charges,31.2% of total billed charges,74.8,80,,,percent of total billed charges,80% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,74.8,
HETEROPHIL ANTIBODY SCREEN,4119431,CDM,300,RC,86308,HCPCS,Outpatient,,,66,33,,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,52.8,80,,,percent of total billed charges,80% of total billed charges ,16,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,16.16,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.84,24,,,percent of total billed charges,24% of total billed charges ,20.59,31.2,,,percent of total billed charges,31.2% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,6.51,52.8,
PREGNENOLONE,4119432,CDM,300,RC,84140,HCPCS,Outpatient,,,276,138,,26,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,220.8,80,,,percent of total billed charges,80% of total billed charges ,66.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,207,75,,,percent of total billed charges,75% of total billed charges ,67.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,26,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.24,24,,,percent of total billed charges,24% of total billed charges ,86.11,31.2,,,percent of total billed charges,31.2% of total billed charges,220.8,80,,,percent of total billed charges,80% of total billed charges,66.24,24,,,percent of total billed charges,24% of total billed charges ,66.24,24,,,percent of total billed charges,24% of total billed charges ,26,220.8,
N-TELOPEPTIDE URINE,4119434,CDM,300,RC,82523,HCPCS,Outpatient,,,210,105,,23.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,50.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,168,80,,,percent of total billed charges,80% of total billed charges ,50.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,105.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,51.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,50.4,24,,,percent of total billed charges,24% of total billed charges ,65.52,31.2,,,percent of total billed charges,31.2% of total billed charges,168,80,,,percent of total billed charges,80% of total billed charges,50.4,24,,,percent of total billed charges,24% of total billed charges ,50.4,24,,,percent of total billed charges,24% of total billed charges ,23.5,168,
TTG IGG AB,4119435,CDM,300,RC,83516,HCPCS,Outpatient,,,103,51.5,,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,77.25,75,,,percent of total billed charges,75% of total billed charges ,77.25,75,,,percent of total billed charges,75% of total billed charges ,24.72,24,,,percent of total billed charges,24% of total billed charges ,77.25,75,,,percent of total billed charges,75% of total billed charges ,77.25,75,,,percent of total billed charges,75% of total billed charges ,82.4,80,,,percent of total billed charges,80% of total billed charges ,24.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,51.91,50.4,,,percent of total billed charges,50.4% of total billed charges ,77.25,75,,,percent of total billed charges,75% of total billed charges ,25.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.72,24,,,percent of total billed charges,24% of total billed charges ,32.14,31.2,,,percent of total billed charges,31.2% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,24.72,24,,,percent of total billed charges,24% of total billed charges ,24.72,24,,,percent of total billed charges,24% of total billed charges ,13.45,82.4,
DIHYDROTESTOSTERONE,4119436,CDM,300,RC,82642,HCPCS,Outpatient,,,344,172,,26.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,82.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,275.2,80,,,percent of total billed charges,80% of total billed charges ,83.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,173.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,258,75,,,percent of total billed charges,75% of total billed charges ,84.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,82.56,24,,,percent of total billed charges,24% of total billed charges ,107.33,31.2,,,percent of total billed charges,31.2% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,82.56,24,,,percent of total billed charges,24% of total billed charges ,82.56,24,,,percent of total billed charges,24% of total billed charges ,26.02,275.2,
IGF BINDING PROTEIN 3,4119437,CDM,300,RC,83520,HCPCS,Outpatient,,,114.5,57.25,,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,16.28,91.6,
COBALT,4119438,CDM,300,RC,83018,HCPCS,Outpatient,,,95,47.5,,27.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
CHROMIUM,4119439,CDM,300,RC,82495,HCPCS,Outpatient,,,45.5,22.75,,25.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,36.4,80,,,percent of total billed charges,80% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,36.4,
THROMBIN TIME,4119440,CDM,300,RC,85670,HCPCS,Outpatient,,,76,38,,7.26,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60.8,80,,,percent of total billed charges,80% of total billed charges ,18.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,38.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,57,75,,,percent of total billed charges,75% of total billed charges ,18.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.26,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.24,24,,,percent of total billed charges,24% of total billed charges ,23.71,31.2,,,percent of total billed charges,31.2% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,18.24,24,,,percent of total billed charges,24% of total billed charges ,18.24,24,,,percent of total billed charges,24% of total billed charges ,7.26,60.8,
TRYPTASE,4119441,CDM,300,RC,83520,HCPCS,Outpatient,,,372,186,,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,89.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,297.6,80,,,percent of total billed charges,80% of total billed charges ,90.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,187.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,279,75,,,percent of total billed charges,75% of total billed charges ,91.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,89.28,24,,,percent of total billed charges,24% of total billed charges ,116.06,31.2,,,percent of total billed charges,31.2% of total billed charges,297.6,80,,,percent of total billed charges,80% of total billed charges,89.28,24,,,percent of total billed charges,24% of total billed charges ,89.28,24,,,percent of total billed charges,24% of total billed charges ,16.28,297.6,
COMPLEMENT C1Q,4119442,CDM,300,RC,86160,HCPCS,Outpatient,,,159.5,79.75,,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,127.6,80,,,percent of total billed charges,80% of total billed charges ,38.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,80.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,39.05,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,38.28,24,,,percent of total billed charges,24% of total billed charges ,49.76,31.2,,,percent of total billed charges,31.2% of total billed charges,127.6,80,,,percent of total billed charges,80% of total billed charges,38.28,24,,,percent of total billed charges,24% of total billed charges ,38.28,24,,,percent of total billed charges,24% of total billed charges ,15.1,127.6,
HEMOCHROMATOSIS PANEL,4119443,CDM,300,RC,81256,HCPCS,Outpatient,,,265.5,132.75,,40,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,63.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,212.4,80,,,percent of total billed charges,80% of total billed charges ,64.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,133.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,64.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,40,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.72,24,,,percent of total billed charges,24% of total billed charges ,82.84,31.2,,,percent of total billed charges,31.2% of total billed charges,212.4,80,,,percent of total billed charges,80% of total billed charges,63.72,24,,,percent of total billed charges,24% of total billed charges ,63.72,24,,,percent of total billed charges,24% of total billed charges ,40,212.4,
JAK2 V617F,4119444,CDM,300,RC,81270,HCPCS,Outpatient,,,64,32,,72,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,72,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,72,
DRUG SCREEN BLOOD,4119445,CDM,300,RC,80375,HCPCS,Outpatient,,,143,71.5,,18.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,114.4,80,,,percent of total billed charges,80% of total billed charges ,34.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,35.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.32,24,,,percent of total billed charges,24% of total billed charges ,44.62,31.2,,,percent of total billed charges,31.2% of total billed charges,114.4,80,,,percent of total billed charges,80% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,18.25,114.4,
NETTLE IGE AB,4119446,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
MUCOR RACEMOSUS IGE AB,4119447,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
S ROSTRATA IGE AB,4119448,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
SHEEP SORREL IGE AB,4119449,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
EUROPEAN HOUSE DUST MITE IGE AB,4119450,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
BERMUDA GRASS IGE AB,4119451,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
TIMOTHY GRASS IGE AB,4119452,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
COCKROACH IGE AB,4119453,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
PENICILLIUM NOTATUM IGE AB,4119454,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
CLADOSPORIUM HERBARUM IGE AB,4119455,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
A FUMIGATUS IGE,4119456,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
MAPLE IGE AB,4119457,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
SILVER BIRCH IGE AB,4119458,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
CEDAR IGE AB,4119459,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
WHITE ELM IGE AB,4119460,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
PECAN/HICKORY TREE IGE AB,4119461,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
COMMON PIGWEED IGE AB,4119462,CDM,300,RC,86003,HCPCS,Outpatient,,,21.5,10.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
GLUCOSE TOLERANCE 1 HOUR,4119463,CDM,300,RC,82951,HCPCS,Outpatient,,,53.5,26.75,,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.13,75,,,percent of total billed charges,75% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,42.8,80,,,percent of total billed charges,80% of total billed charges ,12.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,13.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.84,24,,,percent of total billed charges,24% of total billed charges ,16.69,31.2,,,percent of total billed charges,31.2% of total billed charges,42.8,80,,,percent of total billed charges,80% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,42.8,
PL-7 AB,4119464,CDM,300,RC,83516,HCPCS,Outpatient,,,50,25,,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,37.5,75,,,percent of total billed charges,75% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,12,24,,,percent of total billed charges,24% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,40,80,,,percent of total billed charges,80% of total billed charges ,12.12,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,12.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12,24,,,percent of total billed charges,24% of total billed charges ,15.6,31.2,,,percent of total billed charges,31.2% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,12,24,,,percent of total billed charges,24% of total billed charges ,12,24,,,percent of total billed charges,24% of total billed charges ,12,40,
PL-12 AB,4119465,CDM,300,RC,83516,HCPCS,Outpatient,,,50,25,,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,37.5,75,,,percent of total billed charges,75% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,12,24,,,percent of total billed charges,24% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,40,80,,,percent of total billed charges,80% of total billed charges ,12.12,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,12.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12,24,,,percent of total billed charges,24% of total billed charges ,15.6,31.2,,,percent of total billed charges,31.2% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,12,24,,,percent of total billed charges,24% of total billed charges ,12,24,,,percent of total billed charges,24% of total billed charges ,12,40,
MI-2 AB,4119466,CDM,300,RC,83516,HCPCS,Outpatient,,,50,25,,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,37.5,75,,,percent of total billed charges,75% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,12,24,,,percent of total billed charges,24% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,40,80,,,percent of total billed charges,80% of total billed charges ,12.12,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,12.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12,24,,,percent of total billed charges,24% of total billed charges ,15.6,31.2,,,percent of total billed charges,31.2% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,12,24,,,percent of total billed charges,24% of total billed charges ,12,24,,,percent of total billed charges,24% of total billed charges ,12,40,
KU AB,4119467,CDM,300,RC,83516,HCPCS,Outpatient,,,50,25,,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,37.5,75,,,percent of total billed charges,75% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,12,24,,,percent of total billed charges,24% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,40,80,,,percent of total billed charges,80% of total billed charges ,12.12,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,12.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12,24,,,percent of total billed charges,24% of total billed charges ,15.6,31.2,,,percent of total billed charges,31.2% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,12,24,,,percent of total billed charges,24% of total billed charges ,12,24,,,percent of total billed charges,24% of total billed charges ,12,40,
EJ AB,4119468,CDM,300,RC,83516,HCPCS,Outpatient,,,50,25,,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,37.5,75,,,percent of total billed charges,75% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,12,24,,,percent of total billed charges,24% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,40,80,,,percent of total billed charges,80% of total billed charges ,12.12,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,12.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12,24,,,percent of total billed charges,24% of total billed charges ,15.6,31.2,,,percent of total billed charges,31.2% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,12,24,,,percent of total billed charges,24% of total billed charges ,12,24,,,percent of total billed charges,24% of total billed charges ,12,40,
OJ AB,4119469,CDM,300,RC,86235,HCPCS,Outpatient,,,50,25,,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40,80,,,percent of total billed charges,80% of total billed charges ,12.12,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,12.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12,24,,,percent of total billed charges,24% of total billed charges ,15.6,31.2,,,percent of total billed charges,31.2% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,12,24,,,percent of total billed charges,24% of total billed charges ,12,24,,,percent of total billed charges,24% of total billed charges ,12,40,
MANUAL DIFF PERFORMED,4119470,CDM,300,RC,85007,HCPCS,Outpatient,,,51.5,25.75,,4.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,4.33,41.2,
SRP AB,4119471,CDM,300,RC,86235,HCPCS,Outpatient,,,50,25,,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40,80,,,percent of total billed charges,80% of total billed charges ,12.12,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.5,75,,,percent of total billed charges,75% of total billed charges ,12.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12,24,,,percent of total billed charges,24% of total billed charges ,15.6,31.2,,,percent of total billed charges,31.2% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,12,24,,,percent of total billed charges,24% of total billed charges ,12,24,,,percent of total billed charges,24% of total billed charges ,12,40,
STOOL REDUCING SUBSTANCES,4119472,CDM,300,RC,84376,HCPCS,Outpatient,,,27,13.5,,6.92,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.92,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
REPTILASE TIME,4119473,CDM,300,RC,85635,HCPCS,Outpatient,,,27,13.5,,12.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
PTT HEPARIN NEUTRALIZED,4119474,CDM,300,RC,85730,HCPCS,Outpatient,,,27,13.5,,7.54,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.54,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
PROTEIN C ACTIVITY,4119475,CDM,300,RC,85303,HCPCS,Outpatient,,,222.5,111.25,,17.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,178,80,,,percent of total billed charges,80% of total billed charges ,53.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,166.88,75,,,percent of total billed charges,75% of total billed charges ,54.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,53.4,24,,,percent of total billed charges,24% of total billed charges ,69.42,31.2,,,percent of total billed charges,31.2% of total billed charges,178,80,,,percent of total billed charges,80% of total billed charges,53.4,24,,,percent of total billed charges,24% of total billed charges ,53.4,24,,,percent of total billed charges,24% of total billed charges ,17.39,178,
PROTEIN S ACTIVITY,4119476,CDM,300,RC,85306,HCPCS,Outpatient,,,222.5,111.25,,19.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,178,80,,,percent of total billed charges,80% of total billed charges ,53.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,166.88,75,,,percent of total billed charges,75% of total billed charges ,54.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,53.4,24,,,percent of total billed charges,24% of total billed charges ,69.42,31.2,,,percent of total billed charges,31.2% of total billed charges,178,80,,,percent of total billed charges,80% of total billed charges,53.4,24,,,percent of total billed charges,24% of total billed charges ,53.4,24,,,percent of total billed charges,24% of total billed charges ,19.27,178,
ANTITHROMBIN III AG,4119477,CDM,300,RC,85301,HCPCS,Outpatient,,,222.5,111.25,,13.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,178,80,,,percent of total billed charges,80% of total billed charges ,53.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,166.88,75,,,percent of total billed charges,75% of total billed charges ,54.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,53.4,24,,,percent of total billed charges,24% of total billed charges ,69.42,31.2,,,percent of total billed charges,31.2% of total billed charges,178,80,,,percent of total billed charges,80% of total billed charges,53.4,24,,,percent of total billed charges,24% of total billed charges ,53.4,24,,,percent of total billed charges,24% of total billed charges ,13.6,178,
APTT 1:1 MIX,4119478,CDM,300,RC,85732,HCPCS,Outpatient,,,27,13.5,,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
PLATELET NEUTRALIZATION PROCEDURE,4119479,CDM,300,RC,85597,HCPCS,Outpatient,,,27,13.5,,22.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,22.61,
DRVVT CONFIRMATION,4119480,CDM,300,RC,85597,HCPCS,Outpatient,,,27,13.5,,22.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,22.61,
DRVVT,4119481,CDM,300,RC,85613,HCPCS,Outpatient,,,27,13.5,,12.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
HEXAGONAL PHOSPHOLIPID NEUTRALIZATION,4119482,CDM,300,RC,85598,HCPCS,Outpatient,,,27,13.5,,20.24,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.24,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
DILUTE RUSSELL VIPER,4119483,CDM,300,RC,85613,HCPCS,Outpatient,,,27,13.5,,12.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
"ALLERGY EVALUATION 2, SOUTHEAST",4119499,CDM,300,RC,86003,HCPCS,Outpatient,,,212,106,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,50.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,169.6,80,,,percent of total billed charges,80% of total billed charges ,51.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,106.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,51.9,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,50.88,24,,,percent of total billed charges,24% of total billed charges ,66.14,31.2,,,percent of total billed charges,31.2% of total billed charges,169.6,80,,,percent of total billed charges,80% of total billed charges,50.88,24,,,percent of total billed charges,24% of total billed charges ,50.88,24,,,percent of total billed charges,24% of total billed charges ,6.57,169.6,
HERPESVIRUS 6 ANTIBODIES (IGG & IGM),4119500,CDM,300,RC,86790,HCPCS,Outpatient,,,256.5,128.25,,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,192.38,75,,,percent of total billed charges,75% of total billed charges ,192.38,75,,,percent of total billed charges,75% of total billed charges ,61.56,24,,,percent of total billed charges,24% of total billed charges ,192.38,75,,,percent of total billed charges,75% of total billed charges ,192.38,75,,,percent of total billed charges,75% of total billed charges ,205.2,80,,,percent of total billed charges,80% of total billed charges ,62.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,129.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,192.38,75,,,percent of total billed charges,75% of total billed charges ,62.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.56,24,,,percent of total billed charges,24% of total billed charges ,80.03,31.2,,,percent of total billed charges,31.2% of total billed charges,205.2,80,,,percent of total billed charges,80% of total billed charges,61.56,24,,,percent of total billed charges,24% of total billed charges ,61.56,24,,,percent of total billed charges,24% of total billed charges ,16.2,205.2,
"IODINE, SERUM",4119650,CDM,300,RC,82542,HCPCS,Outpatient,,,397.5,198.75,,7.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,318,80,,,percent of total billed charges,80% of total billed charges ,96.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,200.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,298.13,75,,,percent of total billed charges,75% of total billed charges ,97.31,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,95.4,24,,,percent of total billed charges,24% of total billed charges ,124.02,31.2,,,percent of total billed charges,31.2% of total billed charges,318,80,,,percent of total billed charges,80% of total billed charges,95.4,24,,,percent of total billed charges,24% of total billed charges ,95.4,24,,,percent of total billed charges,24% of total billed charges ,7.55,318,
CYP2B6 GENE,4119700,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
CACNA1C GENE,4119701,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
UGT2B15 GENE,4119702,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
COMT GENE,4119703,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
OPRM1 GENE,4119704,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
ABCG2 GENE,4119705,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
LPA GENE,4119706,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
NOS3 GENE,4119707,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
12Q15 GENE,4119708,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
CYP3A4 GENE,4119709,CDM,310,RC,81230,HCPCS,Outpatient,,,727,363.5,,139.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,174.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,581.6,80,,,percent of total billed charges,80% of total billed charges ,176.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,366.41,50.4,,,percent of total billed charges,50.4% of total billed charges ,545.25,75,,,percent of total billed charges,75% of total billed charges ,177.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,139.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,174.48,24,,,percent of total billed charges,24% of total billed charges ,226.82,31.2,,,percent of total billed charges,31.2% of total billed charges,581.6,80,,,percent of total billed charges,80% of total billed charges,174.48,24,,,percent of total billed charges,24% of total billed charges ,174.48,24,,,percent of total billed charges,24% of total billed charges ,139.85,581.6,
CYP3A5 GENE,4119710,CDM,310,RC,81231,HCPCS,Outpatient,,,727,363.5,,139.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,174.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,581.6,80,,,percent of total billed charges,80% of total billed charges ,176.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,366.41,50.4,,,percent of total billed charges,50.4% of total billed charges ,545.25,75,,,percent of total billed charges,75% of total billed charges ,177.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,139.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,174.48,24,,,percent of total billed charges,24% of total billed charges ,226.82,31.2,,,percent of total billed charges,31.2% of total billed charges,581.6,80,,,percent of total billed charges,80% of total billed charges,174.48,24,,,percent of total billed charges,24% of total billed charges ,174.48,24,,,percent of total billed charges,24% of total billed charges ,139.85,581.6,
APOE GENE,4119711,CDM,310,RC,81401,HCPCS,Outpatient,,,727,363.5,,112,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,174.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,581.6,80,,,percent of total billed charges,80% of total billed charges ,176.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,366.41,50.4,,,percent of total billed charges,50.4% of total billed charges ,545.25,75,,,percent of total billed charges,75% of total billed charges ,177.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,112,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,174.48,24,,,percent of total billed charges,24% of total billed charges ,226.82,31.2,,,percent of total billed charges,31.2% of total billed charges,581.6,80,,,percent of total billed charges,80% of total billed charges,174.48,24,,,percent of total billed charges,24% of total billed charges ,174.48,24,,,percent of total billed charges,24% of total billed charges ,112,581.6,
ANKKI/DRD2 GENE,4119712,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
CYP1A2 GENE,4119713,CDM,310,RC,81402,HCPCS,Outpatient,,,797,398.5,,164,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,191.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,637.6,80,,,percent of total billed charges,80% of total billed charges ,193.19,24.24,,,percent of total billed charges,24.24% of total billed charges ,401.69,50.4,,,percent of total billed charges,50.4% of total billed charges ,597.75,75,,,percent of total billed charges,75% of total billed charges ,195.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,164,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,191.28,24,,,percent of total billed charges,24% of total billed charges ,248.66,31.2,,,percent of total billed charges,31.2% of total billed charges,637.6,80,,,percent of total billed charges,80% of total billed charges,191.28,24,,,percent of total billed charges,24% of total billed charges ,191.28,24,,,percent of total billed charges,24% of total billed charges ,164,637.6,
CYP2C9 GENE,4119714,CDM,310,RC,81227,HCPCS,Outpatient,,,466.5,233.25,,40,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,111.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,373.2,80,,,percent of total billed charges,80% of total billed charges ,113.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,235.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,349.88,75,,,percent of total billed charges,75% of total billed charges ,114.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,40,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,111.96,24,,,percent of total billed charges,24% of total billed charges ,145.55,31.2,,,percent of total billed charges,31.2% of total billed charges,373.2,80,,,percent of total billed charges,80% of total billed charges,111.96,24,,,percent of total billed charges,24% of total billed charges ,111.96,24,,,percent of total billed charges,24% of total billed charges ,40,373.2,
CYP2C19 GENE,4119715,CDM,310,RC,81225,HCPCS,Outpatient,,,778.5,389.25,,244,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,186.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,622.8,80,,,percent of total billed charges,80% of total billed charges ,188.71,24.24,,,percent of total billed charges,24.24% of total billed charges ,392.36,50.4,,,percent of total billed charges,50.4% of total billed charges ,583.88,75,,,percent of total billed charges,75% of total billed charges ,190.58,24.48,,,percent of total billed charges,24.48% of total billed charges ,244,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,186.84,24,,,percent of total billed charges,24% of total billed charges ,242.89,31.2,,,percent of total billed charges,31.2% of total billed charges,622.8,80,,,percent of total billed charges,80% of total billed charges,186.84,24,,,percent of total billed charges,24% of total billed charges ,186.84,24,,,percent of total billed charges,24% of total billed charges ,186.84,622.8,
MTHFR GENE,4119717,CDM,310,RC,81291,HCPCS,Outpatient,,,158.5,79.25,,40,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,126.8,80,,,percent of total billed charges,80% of total billed charges ,38.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,79.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,118.88,75,,,percent of total billed charges,75% of total billed charges ,38.8,24.48,,,percent of total billed charges,24.48% of total billed charges ,40,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,38.04,24,,,percent of total billed charges,24% of total billed charges ,49.45,31.2,,,percent of total billed charges,31.2% of total billed charges,126.8,80,,,percent of total billed charges,80% of total billed charges,38.04,24,,,percent of total billed charges,24% of total billed charges ,38.04,24,,,percent of total billed charges,24% of total billed charges ,38.04,126.8,
FACTOR II (aka F2) GENE,4119718,CDM,300,RC,81240,HCPCS,Outpatient,,,451,225.5,,40,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,108.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,360.8,80,,,percent of total billed charges,80% of total billed charges ,109.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,227.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,338.25,75,,,percent of total billed charges,75% of total billed charges ,110.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,40,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,108.24,24,,,percent of total billed charges,24% of total billed charges ,140.71,31.2,,,percent of total billed charges,31.2% of total billed charges,360.8,80,,,percent of total billed charges,80% of total billed charges,108.24,24,,,percent of total billed charges,24% of total billed charges ,108.24,24,,,percent of total billed charges,24% of total billed charges ,40,360.8,
FACTOR V (LEIDEN) MUTATION ANALYSIS,4119719,CDM,300,RC,81241,HCPCS,Outpatient,,,222.5,111.25,,40,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,178,80,,,percent of total billed charges,80% of total billed charges ,53.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,166.88,75,,,percent of total billed charges,75% of total billed charges ,54.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,40,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,53.4,24,,,percent of total billed charges,24% of total billed charges ,69.42,31.2,,,percent of total billed charges,31.2% of total billed charges,178,80,,,percent of total billed charges,80% of total billed charges,53.4,24,,,percent of total billed charges,24% of total billed charges ,53.4,24,,,percent of total billed charges,24% of total billed charges ,40,178,
VKORC1 GENE,4119721,CDM,310,RC,81355,HCPCS,Outpatient,,,467.5,233.75,,72,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,112.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,374,80,,,percent of total billed charges,80% of total billed charges ,113.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,235.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,350.63,75,,,percent of total billed charges,75% of total billed charges ,114.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,72,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,112.2,24,,,percent of total billed charges,24% of total billed charges ,145.86,31.2,,,percent of total billed charges,31.2% of total billed charges,374,80,,,percent of total billed charges,80% of total billed charges,112.2,24,,,percent of total billed charges,24% of total billed charges ,112.2,24,,,percent of total billed charges,24% of total billed charges ,72,374,
ADRA2A GENE,4119722,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
SLC6A4 GENE,4119723,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
FKBP5 GENE,4119724,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
BDNF GENE,4119725,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
ANK3 GENE,4119726,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
5HT2A GENE,4119727,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
DRD2 GENE,4119728,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
GRIK4 GENE,4119729,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
HTR2A GENE,4119730,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
HTR2C GENE,4119731,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
ANKK1 GENE,4119732,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
ADH1B GENE,4119738,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
ALDH2 GENE,4119739,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
C11orF65 GENE,4119740,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
CYP2C8 GENE,4119741,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
DBH GENE,4119742,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
CPY2B86 GENE,4119743,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
G6PD GENE,4119744,CDM,300,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
GRIK1 GENE,4119745,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
GRIN2B GENE,4119746,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
SCN1A GENE,4119747,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
SLC47A2 GENE,4119748,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
ALC6A4 GENE,4119749,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
TPMT GENE,4119750,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
ITGB3 GENE,4119751,CDM,301,RC,81479,HCPCS,Outpatient,,,277,138.5,,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,221.6,80,,,percent of total billed charges,80% of total billed charges ,67.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,67.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,890.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.48,24,,,percent of total billed charges,24% of total billed charges ,86.42,31.2,,,percent of total billed charges,31.2% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,24,,,percent of total billed charges,24% of total billed charges ,66.48,890.08,
"CATECHOLAMINES, FRAC, PLASMA",4119752,CDM,301,RC,82384,HCPCS,Outpatient,,,99,49.5,,31.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,79.2,80,,,percent of total billed charges,80% of total billed charges ,24,24.24,,,percent of total billed charges,24.24% of total billed charges ,49.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,74.25,75,,,percent of total billed charges,75% of total billed charges ,24.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.76,24,,,percent of total billed charges,24% of total billed charges ,30.89,31.2,,,percent of total billed charges,31.2% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,23.76,24,,,percent of total billed charges,24% of total billed charges ,23.76,24,,,percent of total billed charges,24% of total billed charges ,23.76,79.2,
"HER 2, FISH, PARAFFIN",4119753,CDM,312,RC,88377,HCPCS,Outpatient,,,604.5,302.25,,181.64,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,145.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,483.6,80,,,percent of total billed charges,80% of total billed charges ,146.53,24.24,,,percent of total billed charges,24.24% of total billed charges ,304.67,50.4,,,percent of total billed charges,50.4% of total billed charges ,453.38,75,,,percent of total billed charges,75% of total billed charges ,147.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,181.64,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,145.08,24,,,percent of total billed charges,24% of total billed charges ,188.6,31.2,,,percent of total billed charges,31.2% of total billed charges,483.6,80,,,percent of total billed charges,80% of total billed charges,145.08,24,,,percent of total billed charges,24% of total billed charges ,145.08,24,,,percent of total billed charges,24% of total billed charges ,145.08,483.6,
"Ki 67, IHC",4119754,CDM,312,RC,88360,HCPCS,Outpatient,,,414,207,,97.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,99.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,331.2,80,,,percent of total billed charges,80% of total billed charges ,100.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,208.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,310.5,75,,,percent of total billed charges,75% of total billed charges ,101.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,97.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,99.36,24,,,percent of total billed charges,24% of total billed charges ,129.17,31.2,,,percent of total billed charges,31.2% of total billed charges,331.2,80,,,percent of total billed charges,80% of total billed charges,99.36,24,,,percent of total billed charges,24% of total billed charges ,99.36,24,,,percent of total billed charges,24% of total billed charges ,97.65,331.2,
"HER 2, IHC",4119755,CDM,312,RC,88360,HCPCS,Outpatient,,,177,88.5,,97.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,141.6,80,,,percent of total billed charges,80% of total billed charges ,42.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,132.75,75,,,percent of total billed charges,75% of total billed charges ,43.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,97.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.48,24,,,percent of total billed charges,24% of total billed charges ,55.22,31.2,,,percent of total billed charges,31.2% of total billed charges,141.6,80,,,percent of total billed charges,80% of total billed charges,42.48,24,,,percent of total billed charges,24% of total billed charges ,42.48,24,,,percent of total billed charges,24% of total billed charges ,42.48,141.6,
DNA CELL CYCLE ANALYSIS,4119756,CDM,311,RC,88182,HCPCS,Outpatient,,,196.5,98.25,,66.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,157.2,80,,,percent of total billed charges,80% of total billed charges ,47.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,99.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,147.38,75,,,percent of total billed charges,75% of total billed charges ,48.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,66.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.16,24,,,percent of total billed charges,24% of total billed charges ,61.31,31.2,,,percent of total billed charges,31.2% of total billed charges,157.2,80,,,percent of total billed charges,80% of total billed charges,47.16,24,,,percent of total billed charges,24% of total billed charges ,47.16,24,,,percent of total billed charges,24% of total billed charges ,47.16,157.2,
SALIVA DRUG CONFIRMATION TESTING,4119757,CDM,300,RC,G0480,HCPCS,Outpatient,,,,,,94.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,94.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,94.12,94.12,
URINE DRUG CONFIRMATION TEST,4119758,CDM,300,RC,G0480,HCPCS,Outpatient,,,,,,94.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,94.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,94.12,94.12,
PARIETAL CELL ANTIBODY W/ REFLEX,4119759,CDM,300,RC,86255,HCPCS,Outpatient,,,53.5,26.75,,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.8,80,,,percent of total billed charges,80% of total billed charges ,12.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,13.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.84,24,,,percent of total billed charges,24% of total billed charges ,16.69,31.2,,,percent of total billed charges,31.2% of total billed charges,42.8,80,,,percent of total billed charges,80% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,42.8,
.URINE CULTURE WORKUP,4119761,CDM,300,RC,87088,HCPCS,Outpatient,,,,,,10.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.18,10.18,
.EYE CULTURE WORKUP,4119762,CDM,300,RC,87070,HCPCS,Outpatient,,,,,,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.83,10.83,
.EAR CULTURE WORKUP,4119763,CDM,300,RC,87070,HCPCS,Outpatient,,,,,,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.83,10.83,
.SPUTUM CULTURE WORKUP,4119764,CDM,300,RC,87070,HCPCS,Outpatient,,,,,,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.83,10.83,
.THROAT CULTURE WORKUP,4119765,CDM,300,RC,87070,HCPCS,Outpatient,,,,,,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.83,10.83,
".WOUND CULTURE WORKUP, AEROBIC",4119766,CDM,300,RC,87070,HCPCS,Outpatient,,,,,,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.83,10.83,
.BLOOD CULTURE WORKUP,4119767,CDM,300,RC,87040,HCPCS,Outpatient,,,,,,12.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.98,12.98,
"GIARDIA LAMBLIA IGG, IGM, IGA PANEL",4119768,CDM,300,RC,87329,HCPCS,Outpatient,,,173,86.5,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,41.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,138.4,80,,,percent of total billed charges,80% of total billed charges ,41.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,87.19,50.4,,,percent of total billed charges,50.4% of total billed charges ,129.75,75,,,percent of total billed charges,75% of total billed charges ,42.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,41.52,24,,,percent of total billed charges,24% of total billed charges ,53.98,31.2,,,percent of total billed charges,31.2% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,41.52,24,,,percent of total billed charges,24% of total billed charges ,41.52,24,,,percent of total billed charges,24% of total billed charges ,15.08,138.4,
HCV RNA QUALITATIVE,4119769,CDM,300,RC,87521,HCPCS,Outpatient,,,138,69,,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,103.5,75,,,percent of total billed charges,75% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,33.12,24,,,percent of total billed charges,24% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,110.4,80,,,percent of total billed charges,80% of total billed charges ,33.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,69.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,33.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.12,24,,,percent of total billed charges,24% of total billed charges ,43.06,31.2,,,percent of total billed charges,31.2% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,33.12,24,,,percent of total billed charges,24% of total billed charges ,33.12,24,,,percent of total billed charges,24% of total billed charges ,24.67,110.4,
DELETED....,4119770,CDM,300,RC,87522,HCPCS,Outpatient,,,202,101,,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,151.5,75,,,percent of total billed charges,75% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,48.48,24,,,percent of total billed charges,24% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,161.6,80,,,percent of total billed charges,80% of total billed charges ,48.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,101.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,49.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,48.48,24,,,percent of total billed charges,24% of total billed charges ,63.02,31.2,,,percent of total billed charges,31.2% of total billed charges,161.6,80,,,percent of total billed charges,80% of total billed charges,48.48,24,,,percent of total billed charges,24% of total billed charges ,48.48,24,,,percent of total billed charges,24% of total billed charges ,48.48,161.6,
TUMOR IMMUNOHISTOCHEMISTRY STAIN,4119771,CDM,312,RC,88360,HCPCS,Outpatient,,,397.5,198.75,,97.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,318,80,,,percent of total billed charges,80% of total billed charges ,96.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,200.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,298.13,75,,,percent of total billed charges,75% of total billed charges ,97.31,24.48,,,percent of total billed charges,24.48% of total billed charges ,97.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,95.4,24,,,percent of total billed charges,24% of total billed charges ,124.02,31.2,,,percent of total billed charges,31.2% of total billed charges,318,80,,,percent of total billed charges,80% of total billed charges,95.4,24,,,percent of total billed charges,24% of total billed charges ,95.4,24,,,percent of total billed charges,24% of total billed charges ,95.4,318,
THALLIUM,4119772,CDM,301,RC,83018,HCPCS,Outpatient,,,77.5,38.75,,27.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62,80,,,percent of total billed charges,80% of total billed charges ,18.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,18.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.6,24,,,percent of total billed charges,24% of total billed charges ,24.18,31.2,,,percent of total billed charges,31.2% of total billed charges,62,80,,,percent of total billed charges,80% of total billed charges,18.6,24,,,percent of total billed charges,24% of total billed charges ,18.6,24,,,percent of total billed charges,24% of total billed charges ,18.6,62,
"CALPROTECTIN, STOOL",4119773,CDM,301,RC,83993,HCPCS,Outpatient,,,69,34.5,,24.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.2,80,,,percent of total billed charges,80% of total billed charges ,16.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.56,24,,,percent of total billed charges,24% of total billed charges ,21.53,31.2,,,percent of total billed charges,31.2% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,55.2,
"MICROALBUMIN w/o CREATININE, 24 HR URINE",4119774,CDM,301,RC,82043,HCPCS,Outpatient,,,20.5,10.25,,7.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
"CARBAMAZEPINE, FREE",4119775,CDM,301,RC,80157,HCPCS,Outpatient,,,47.5,23.75,,12.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
"HEPATITIS B SURFACE ABY IMMUNITY, QUANT",4119776,CDM,301,RC,86317,HCPCS,Outpatient,,,52.5,26.25,,15.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.38,75,,,percent of total billed charges,75% of total billed charges ,39.38,75,,,percent of total billed charges,75% of total billed charges ,12.6,24,,,percent of total billed charges,24% of total billed charges ,39.38,75,,,percent of total billed charges,75% of total billed charges ,39.38,75,,,percent of total billed charges,75% of total billed charges ,42,80,,,percent of total billed charges,80% of total billed charges ,12.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.46,50.4,,,percent of total billed charges,50.4% of total billed charges ,39.38,75,,,percent of total billed charges,75% of total billed charges ,12.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.6,24,,,percent of total billed charges,24% of total billed charges ,16.38,31.2,,,percent of total billed charges,31.2% of total billed charges,42,80,,,percent of total billed charges,80% of total billed charges,12.6,24,,,percent of total billed charges,24% of total billed charges ,12.6,24,,,percent of total billed charges,24% of total billed charges ,12.6,42,
HEPATITIS B SURF AG CONFIRMATION,4119777,CDM,300,RC,87341,HCPCS,Outpatient,,,48.5,24.25,,12.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.8,80,,,percent of total billed charges,80% of total billed charges ,11.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.64,24,,,percent of total billed charges,24% of total billed charges ,15.13,31.2,,,percent of total billed charges,31.2% of total billed charges,38.8,80,,,percent of total billed charges,80% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,38.8,
PTH RELATED PROTEIN,4119778,CDM,300,RC,83519,HCPCS,Outpatient,,,78.5,39.25,,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.8,80,,,percent of total billed charges,80% of total billed charges ,19.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.88,75,,,percent of total billed charges,75% of total billed charges ,19.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.84,24,,,percent of total billed charges,24% of total billed charges ,24.49,31.2,,,percent of total billed charges,31.2% of total billed charges,62.8,80,,,percent of total billed charges,80% of total billed charges,18.84,24,,,percent of total billed charges,24% of total billed charges ,18.84,24,,,percent of total billed charges,24% of total billed charges ,16.99,62.8,
MYCOPLASMA PNEUMONIA IGG,4119779,CDM,300,RC,86738,HCPCS,Outpatient,,,178,89,,16.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,16.66,142.4,
"GIARDIA ANTIGEN, STOOL",4119782,CDM,300,RC,87329,HCPCS,Outpatient,,,56.5,28.25,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
BB AHG CROSSMATCH SHEPARD,4119783,CDM,300,RC,86922,HCPCS,Outpatient,,,328.5,164.25,,88.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,78.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,262.8,80,,,percent of total billed charges,80% of total billed charges ,79.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,165.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,246.38,75,,,percent of total billed charges,75% of total billed charges ,80.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,88.24,26.86,,,percent of total billed charges,26.86% of total billed charges,78.84,24,,,percent of total billed charges,24% of total billed charges ,102.49,31.2,,,percent of total billed charges,31.2% of total billed charges,262.8,80,,,percent of total billed charges,80% of total billed charges,78.84,24,,,percent of total billed charges,24% of total billed charges ,78.84,24,,,percent of total billed charges,24% of total billed charges ,78.84,262.8,
TRAb (TSH Receptor Binding Aby),4119784,CDM,300,RC,83519,HCPCS,Outpatient,,,78.5,39.25,,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.8,80,,,percent of total billed charges,80% of total billed charges ,19.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.88,75,,,percent of total billed charges,75% of total billed charges ,19.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.84,24,,,percent of total billed charges,24% of total billed charges ,24.49,31.2,,,percent of total billed charges,31.2% of total billed charges,62.8,80,,,percent of total billed charges,80% of total billed charges,18.84,24,,,percent of total billed charges,24% of total billed charges ,18.84,24,,,percent of total billed charges,24% of total billed charges ,16.99,62.8,
"TRICHOMONAS VAGINALIS, RNA, MALES",4119785,CDM,300,RC,87661,HCPCS,Outpatient,,,166,83,,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,21.42,132.8,
OVA & PARASITE SMEAR,4119786,CDM,300,RC,87177,HCPCS,Outpatient,,,42,21,,11.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.6,80,,,percent of total billed charges,80% of total billed charges ,10.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.08,24,,,percent of total billed charges,24% of total billed charges ,13.1,31.2,,,percent of total billed charges,31.2% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,33.6,
OVA & PARASITE STAIN,4119787,CDM,300,RC,87209,HCPCS,Outpatient,,,84.5,42.25,,22.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,67.6,80,,,percent of total billed charges,80% of total billed charges ,20.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,20.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.28,24,,,percent of total billed charges,24% of total billed charges ,26.36,31.2,,,percent of total billed charges,31.2% of total billed charges,67.6,80,,,percent of total billed charges,80% of total billed charges,20.28,24,,,percent of total billed charges,24% of total billed charges ,20.28,24,,,percent of total billed charges,24% of total billed charges ,20.28,67.6,
OVA & PARASITE W/ GIARDIA ANTIGEN,4119788,CDM,999,RC,87177,HCPCS,Outpatient,,,180.5,90.25,,11.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,43.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,144.4,80,,,percent of total billed charges,80% of total billed charges ,43.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,90.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,44.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,43.32,24,,,percent of total billed charges,24% of total billed charges ,56.32,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,43.32,24,,,percent of total billed charges,24% of total billed charges ,43.32,24,,,percent of total billed charges,24% of total billed charges ,11.19,144.4,
"ENTAMOEBA HISTOLYTICA, AG",4119789,CDM,300,RC,87337,HCPCS,Outpatient,,,56.5,28.25,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
"PARIETAL CELL ANTIBODY, ELISA",4119790,CDM,300,RC,83516,HCPCS,Outpatient,,,54.5,27.25,,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.88,75,,,percent of total billed charges,75% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,13.08,24,,,percent of total billed charges,24% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,43.6,80,,,percent of total billed charges,80% of total billed charges ,13.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,27.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,13.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.08,24,,,percent of total billed charges,24% of total billed charges ,17,31.2,,,percent of total billed charges,31.2% of total billed charges,43.6,80,,,percent of total billed charges,80% of total billed charges,13.08,24,,,percent of total billed charges,24% of total billed charges ,13.08,24,,,percent of total billed charges,24% of total billed charges ,13.08,43.6,
CARDIOLIPIN Antibody IgG,4119791,CDM,300,RC,86147,HCPCS,Outpatient,,,150.5,75.25,,31.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,120.4,80,,,percent of total billed charges,80% of total billed charges ,36.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,75.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,112.88,75,,,percent of total billed charges,75% of total billed charges ,36.84,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,36.12,24,,,percent of total billed charges,24% of total billed charges ,46.96,31.2,,,percent of total billed charges,31.2% of total billed charges,120.4,80,,,percent of total billed charges,80% of total billed charges,36.12,24,,,percent of total billed charges,24% of total billed charges ,36.12,24,,,percent of total billed charges,24% of total billed charges ,31.99,120.4,
CARDIOLIPIN ANTIBODY IgM,4119792,CDM,300,RC,86147,HCPCS,Outpatient,,,150.5,75.25,,31.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,120.4,80,,,percent of total billed charges,80% of total billed charges ,36.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,75.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,112.88,75,,,percent of total billed charges,75% of total billed charges ,36.84,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,36.12,24,,,percent of total billed charges,24% of total billed charges ,46.96,31.2,,,percent of total billed charges,31.2% of total billed charges,120.4,80,,,percent of total billed charges,80% of total billed charges,36.12,24,,,percent of total billed charges,24% of total billed charges ,36.12,24,,,percent of total billed charges,24% of total billed charges ,31.99,120.4,
Antiphospholipid antibody IgA,4119793,CDM,300,RC,86148,HCPCS,Outpatient,,,95,47.5,,20.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,20.2,76,
Antiphospholipid antibody IgG,4119794,CDM,300,RC,86148,HCPCS,Outpatient,,,95,47.5,,20.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,20.2,76,
Antiphospholipid antibody IgM,4119795,CDM,300,RC,86148,HCPCS,Outpatient,,,95,47.5,,20.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,20.2,76,
Beta 2 Glycoprotein I Antibody IgA,4119796,CDM,300,RC,86146,HCPCS,Outpatient,,,150.5,75.25,,31.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,120.4,80,,,percent of total billed charges,80% of total billed charges ,36.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,75.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,112.88,75,,,percent of total billed charges,75% of total billed charges ,36.84,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,36.12,24,,,percent of total billed charges,24% of total billed charges ,46.96,31.2,,,percent of total billed charges,31.2% of total billed charges,120.4,80,,,percent of total billed charges,80% of total billed charges,36.12,24,,,percent of total billed charges,24% of total billed charges ,36.12,24,,,percent of total billed charges,24% of total billed charges ,31.99,120.4,
Beta 2 Glycoprotein I Antibody IgM,4119797,CDM,300,RC,86146,HCPCS,Outpatient,,,150.5,75.25,,31.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,120.4,80,,,percent of total billed charges,80% of total billed charges ,36.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,75.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,112.88,75,,,percent of total billed charges,75% of total billed charges ,36.84,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,36.12,24,,,percent of total billed charges,24% of total billed charges ,46.96,31.2,,,percent of total billed charges,31.2% of total billed charges,120.4,80,,,percent of total billed charges,80% of total billed charges,36.12,24,,,percent of total billed charges,24% of total billed charges ,36.12,24,,,percent of total billed charges,24% of total billed charges ,31.99,120.4,
Beta 2 Glycoprotein I Antibody IgG,4119798,CDM,300,RC,86146,HCPCS,Outpatient,,,150.5,75.25,,31.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,120.4,80,,,percent of total billed charges,80% of total billed charges ,36.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,75.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,112.88,75,,,percent of total billed charges,75% of total billed charges ,36.84,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,36.12,24,,,percent of total billed charges,24% of total billed charges ,46.96,31.2,,,percent of total billed charges,31.2% of total billed charges,120.4,80,,,percent of total billed charges,80% of total billed charges,36.12,24,,,percent of total billed charges,24% of total billed charges ,36.12,24,,,percent of total billed charges,24% of total billed charges ,31.99,120.4,
ANTIPHOSPHOLIPID ANTIBODY PANEL,4119799,CDM,999,RC,86146,HCPCS,Outpatient,,,669.5,334.75,,31.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,160.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,535.6,80,,,percent of total billed charges,80% of total billed charges ,162.29,24.24,,,percent of total billed charges,24.24% of total billed charges ,337.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,502.13,75,,,percent of total billed charges,75% of total billed charges ,163.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,160.68,24,,,percent of total billed charges,24% of total billed charges ,208.88,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,160.68,24,,,percent of total billed charges,24% of total billed charges ,160.68,24,,,percent of total billed charges,24% of total billed charges ,31.99,535.6,
"BRCA, COMPREHENSIVE",4119800,CDM,300,RC,81162,HCPCS,Outpatient,,,8211,4105.5,,1988.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1970.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6568.8,80,,,percent of total billed charges,80% of total billed charges ,1990.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,4138.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,6158.25,75,,,percent of total billed charges,75% of total billed charges ,2010.05,24.48,,,percent of total billed charges,24.48% of total billed charges ,1988.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,1970.64,24,,,percent of total billed charges,24% of total billed charges ,2561.83,31.2,,,percent of total billed charges,31.2% of total billed charges,6568.8,80,,,percent of total billed charges,80% of total billed charges,1970.64,24,,,percent of total billed charges,24% of total billed charges ,1970.64,24,,,percent of total billed charges,24% of total billed charges ,1970.64,6568.8,
RICKETTSIA (RMSF) TITER,4119801,CDM,300,RC,86757,HCPCS,Outpatient,,,91.5,45.75,,24.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.63,75,,,percent of total billed charges,75% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,21.96,24,,,percent of total billed charges,24% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,73.2,80,,,percent of total billed charges,80% of total billed charges ,22.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,46.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,22.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.96,24,,,percent of total billed charges,24% of total billed charges ,28.55,31.2,,,percent of total billed charges,31.2% of total billed charges,73.2,80,,,percent of total billed charges,80% of total billed charges,21.96,24,,,percent of total billed charges,24% of total billed charges ,21.96,24,,,percent of total billed charges,24% of total billed charges ,21.96,73.2,
VIT D 25 with D2 & D3 SUBSETS,4119802,CDM,300,RC,82306,HCPCS,Outpatient,,,140,70,,37.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,112,80,,,percent of total billed charges,80% of total billed charges ,33.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,70.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,34.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.6,24,,,percent of total billed charges,24% of total billed charges ,43.68,31.2,,,percent of total billed charges,31.2% of total billed charges,112,80,,,percent of total billed charges,80% of total billed charges,33.6,24,,,percent of total billed charges,24% of total billed charges ,33.6,24,,,percent of total billed charges,24% of total billed charges ,33.6,112,
PARIETAL CELL ANTIBODY TITER CHG,4119805,CDM,300,RC,86256,HCPCS,Outpatient,,,56.5,28.25,,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
CLOZAPINE,4119806,CDM,301,RC,80159,HCPCS,Outpatient,,,87.5,43.75,,20.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,70,80,,,percent of total billed charges,80% of total billed charges ,21.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,44.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,65.63,75,,,percent of total billed charges,75% of total billed charges ,21.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21,24,,,percent of total billed charges,24% of total billed charges ,27.3,31.2,,,percent of total billed charges,31.2% of total billed charges,70,80,,,percent of total billed charges,80% of total billed charges,21,24,,,percent of total billed charges,24% of total billed charges ,21,24,,,percent of total billed charges,24% of total billed charges ,20.18,70,
ADALIMUMAB LEVEL FOR IBD,4119807,CDM,301,RC,80299,HCPCS,Outpatient,,,79.5,39.75,,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,63.6,80,,,percent of total billed charges,80% of total billed charges ,19.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,40.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,19.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,19.08,24,,,percent of total billed charges,24% of total billed charges ,24.8,31.2,,,percent of total billed charges,31.2% of total billed charges,63.6,80,,,percent of total billed charges,80% of total billed charges,19.08,24,,,percent of total billed charges,24% of total billed charges ,19.08,24,,,percent of total billed charges,24% of total billed charges ,15.14,63.6,
ssDNA ANTIBODY (IGG),4119808,CDM,301,RC,86226,HCPCS,Outpatient,,,56.5,28.25,,15.23,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.23,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
JO1 ANTIBODY,4119809,CDM,300,RC,86235,HCPCS,Outpatient,,,166,83,,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,22.55,132.8,
SALMONELLA & SHIGELLA CULTURE,4119810,CDM,300,RC,87045,HCPCS,Outpatient,,,44.5,22.25,,11.95,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.6,80,,,percent of total billed charges,80% of total billed charges ,10.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,10.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.95,26.86,,,percent of total billed charges,26.86% of total billed charges,10.68,24,,,percent of total billed charges,24% of total billed charges ,13.88,31.2,,,percent of total billed charges,31.2% of total billed charges,35.6,80,,,percent of total billed charges,80% of total billed charges,10.68,24,,,percent of total billed charges,24% of total billed charges ,10.68,24,,,percent of total billed charges,24% of total billed charges ,10.68,35.6,
CAMPYLOBACTER CULTURE,4119811,CDM,300,RC,87046,HCPCS,Outpatient,,,44.5,22.25,,2.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.6,80,,,percent of total billed charges,80% of total billed charges ,10.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,10.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.68,24,,,percent of total billed charges,24% of total billed charges ,13.88,31.2,,,percent of total billed charges,31.2% of total billed charges,35.6,80,,,percent of total billed charges,80% of total billed charges,10.68,24,,,percent of total billed charges,24% of total billed charges ,10.68,24,,,percent of total billed charges,24% of total billed charges ,2.97,35.6,
BARTONELLA  QUINTANA  IGG,4119813,CDM,300,RC,86611,HCPCS,Outpatient,,,284.5,142.25,,12.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,12.8,227.6,
BARTONELLA QUINTANA IGM,4119814,CDM,300,RC,86611,HCPCS,Outpatient,,,284.5,142.25,,12.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,12.8,227.6,
BB ANTIBODY SCREEN SHEPEARD,4119815,CDM,300,RC,86850,HCPCS,Outpatient,,,357.5,178.75,,15.23,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,286,80,,,percent of total billed charges,80% of total billed charges ,86.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,180.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,87.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.23,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.8,24,,,percent of total billed charges,24% of total billed charges ,111.54,31.2,,,percent of total billed charges,31.2% of total billed charges,286,80,,,percent of total billed charges,80% of total billed charges,85.8,24,,,percent of total billed charges,24% of total billed charges ,85.8,24,,,percent of total billed charges,24% of total billed charges ,15.23,286,
BB ABO BLOOD TYPE SHEPEARD,4119816,CDM,300,RC,86900,HCPCS,Outpatient,,,101,50.5,,3.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,3.75,80.8,
BB RH SHEPEARD,4119817,CDM,300,RC,86901,HCPCS,Outpatient,,,101,50.5,,14.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,14.51,80.8,
VARICELLA ZOSTER IGM,4119818,CDM,300,RC,86787,HCPCS,Outpatient,,,166,83,,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,16.2,132.8,
LYMPHOCYTE SUBSET PANEL 5,4119819,CDM,300,RC,86361,HCPCS,Outpatient,,,126.5,63.25,,32.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,94.88,75,,,percent of total billed charges,75% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,30.36,24,,,percent of total billed charges,24% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,101.2,80,,,percent of total billed charges,80% of total billed charges ,30.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,63.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,94.88,75,,,percent of total billed charges,75% of total billed charges ,30.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,30.36,24,,,percent of total billed charges,24% of total billed charges ,39.47,31.2,,,percent of total billed charges,31.2% of total billed charges,101.2,80,,,percent of total billed charges,80% of total billed charges,30.36,24,,,percent of total billed charges,24% of total billed charges ,30.36,24,,,percent of total billed charges,24% of total billed charges ,30.36,101.2,
ALPHA-1 ANTITRYPSIN (AAT) MUTATION ANYLS,4119820,CDM,300,RC,81332,HCPCS,Outpatient,,,206,103,,40,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,164.8,80,,,percent of total billed charges,80% of total billed charges ,49.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,103.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,50.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,40,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,49.44,24,,,percent of total billed charges,24% of total billed charges ,64.27,31.2,,,percent of total billed charges,31.2% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,40,164.8,
H PYLORI BREATH TEST,4119821,CDM,300,RC,83013,HCPCS,Outpatient,,,238,119,,66.53,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,190.4,80,,,percent of total billed charges,80% of total billed charges ,57.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,178.5,75,,,percent of total billed charges,75% of total billed charges ,58.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,66.53,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,57.12,24,,,percent of total billed charges,24% of total billed charges ,74.26,31.2,,,percent of total billed charges,31.2% of total billed charges,190.4,80,,,percent of total billed charges,80% of total billed charges,57.12,24,,,percent of total billed charges,24% of total billed charges ,57.12,24,,,percent of total billed charges,24% of total billed charges ,57.12,190.4,
"TRICHOMONAS VAGINALIS, RNA, QUAL, TMA",4119822,CDM,300,RC,87661,HCPCS,Outpatient,,,166,83,,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,21.42,132.8,
PATHOLOGY - ANTIBODY STAINS - 88341,4119823,CDM,312,RC,88341,HCPCS,Outpatient,,,207,103.5,,57.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,165.6,80,,,percent of total billed charges,80% of total billed charges ,50.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,104.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,155.25,75,,,percent of total billed charges,75% of total billed charges ,50.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,57.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,49.68,24,,,percent of total billed charges,24% of total billed charges ,64.58,31.2,,,percent of total billed charges,31.2% of total billed charges,165.6,80,,,percent of total billed charges,80% of total billed charges,49.68,24,,,percent of total billed charges,24% of total billed charges ,49.68,24,,,percent of total billed charges,24% of total billed charges ,49.68,165.6,
"CRYPTOSPORIDIUM ANTIGEN, EIA",4119824,CDM,300,RC,87328,HCPCS,Outpatient,,,166,83,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,15.08,132.8,
ORAL FLUID DRUG SCREEN & CONFIRM.,4119825,CDM,300,RC,80307,HCPCS,Outpatient,,,243,121.5,,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,194.4,80,,,percent of total billed charges,80% of total billed charges ,58.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,122.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,182.25,75,,,percent of total billed charges,75% of total billed charges ,59.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,58.32,24,,,percent of total billed charges,24% of total billed charges ,75.82,31.2,,,percent of total billed charges,31.2% of total billed charges,194.4,80,,,percent of total billed charges,80% of total billed charges,58.32,24,,,percent of total billed charges,24% of total billed charges ,58.32,24,,,percent of total billed charges,24% of total billed charges ,58.32,194.4,
HSV 1 IGM AB,4119826,CDM,300,RC,86695,HCPCS,Outpatient,,,256.5,128.25,,16.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,205.2,80,,,percent of total billed charges,80% of total billed charges ,62.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,129.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,192.38,75,,,percent of total billed charges,75% of total billed charges ,62.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.56,24,,,percent of total billed charges,24% of total billed charges ,80.03,31.2,,,percent of total billed charges,31.2% of total billed charges,205.2,80,,,percent of total billed charges,80% of total billed charges,61.56,24,,,percent of total billed charges,24% of total billed charges ,61.56,24,,,percent of total billed charges,24% of total billed charges ,16.59,205.2,
FUNGAL ISOLATE IDENTIFICATION,4119827,CDM,300,RC,87107,HCPCS,Outpatient,,,48.5,24.25,,12.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.8,80,,,percent of total billed charges,80% of total billed charges ,11.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.64,24,,,percent of total billed charges,24% of total billed charges ,15.13,31.2,,,percent of total billed charges,31.2% of total billed charges,38.8,80,,,percent of total billed charges,80% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,38.8,
APOLIPROTEIN A,4119828,CDM,301,RC,82172,HCPCS,Outpatient,,,203,101.5,,19.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,162.4,80,,,percent of total billed charges,80% of total billed charges ,49.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,102.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,152.25,75,,,percent of total billed charges,75% of total billed charges ,49.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,48.72,24,,,percent of total billed charges,24% of total billed charges ,63.34,31.2,,,percent of total billed charges,31.2% of total billed charges,162.4,80,,,percent of total billed charges,80% of total billed charges,48.72,24,,,percent of total billed charges,24% of total billed charges ,48.72,24,,,percent of total billed charges,24% of total billed charges ,19.49,162.4,
SMOOTH MUSCLE ANTIBODY TITER CHG,4119830,CDM,300,RC,86256,HCPCS,Outpatient,,,56.5,28.25,,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
COVID-19 PCR TEST - QUEST,4119832,CDM,300,RC,87635,HCPCS,Outpatient,,,424.5,212.25,,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,339.6,80,,,percent of total billed charges,80% of total billed charges ,102.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,213.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,103.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,101.88,24,,,percent of total billed charges,24% of total billed charges ,132.44,31.2,,,percent of total billed charges,31.2% of total billed charges,339.6,80,,,percent of total billed charges,80% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,51.31,339.6,
OXIDIZED LDL,4119833,CDM,300,RC,83520,HCPCS,Outpatient,,,222.5,111.25,,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,178,80,,,percent of total billed charges,80% of total billed charges ,53.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,166.88,75,,,percent of total billed charges,75% of total billed charges ,54.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,53.4,24,,,percent of total billed charges,24% of total billed charges ,69.42,31.2,,,percent of total billed charges,31.2% of total billed charges,178,80,,,percent of total billed charges,80% of total billed charges,53.4,24,,,percent of total billed charges,24% of total billed charges ,53.4,24,,,percent of total billed charges,24% of total billed charges ,16.28,178,
COVID 19 Antibody IgM & IgG,4119834,CDM,300,RC,86769,HCPCS,Outpatient,,,227.5,113.75,,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,170.63,75,,,percent of total billed charges,75% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,54.6,24,,,percent of total billed charges,24% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,182,80,,,percent of total billed charges,80% of total billed charges ,55.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,114.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,55.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.6,24,,,percent of total billed charges,24% of total billed charges ,70.98,31.2,,,percent of total billed charges,31.2% of total billed charges,182,80,,,percent of total billed charges,80% of total billed charges,54.6,24,,,percent of total billed charges,24% of total billed charges ,54.6,24,,,percent of total billed charges,24% of total billed charges ,51.31,182,
COVID-19 PCR TEST - HORIZON LAB,4119835,CDM,300,RC,87635,HCPCS,Outpatient,,,424.5,212.25,,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,339.6,80,,,percent of total billed charges,80% of total billed charges ,102.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,213.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,103.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,101.88,24,,,percent of total billed charges,24% of total billed charges ,132.44,31.2,,,percent of total billed charges,31.2% of total billed charges,339.6,80,,,percent of total billed charges,80% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,51.31,339.6,
"GI PROFILE, STOOL, PCR, LABCORP",4119837,CDM,300,RC,87045,HCPCS,Outpatient,,,518,259,,139.13,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,124.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,414.4,80,,,percent of total billed charges,80% of total billed charges ,125.56,24.24,,,percent of total billed charges,24.24% of total billed charges ,261.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,388.5,75,,,percent of total billed charges,75% of total billed charges ,126.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,139.13,26.86,,,percent of total billed charges,26.86% of total billed charges,124.32,24,,,percent of total billed charges,24% of total billed charges ,161.62,31.2,,,percent of total billed charges,31.2% of total billed charges,414.4,80,,,percent of total billed charges,80% of total billed charges,124.32,24,,,percent of total billed charges,24% of total billed charges ,124.32,24,,,percent of total billed charges,24% of total billed charges ,124.32,414.4,
SARS CoV-2 IgG (QUEST),4119838,CDM,301,RC,86769,HCPCS,Outpatient,,,133,66.5,,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,99.75,75,,,percent of total billed charges,75% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,31.92,24,,,percent of total billed charges,24% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,106.4,80,,,percent of total billed charges,80% of total billed charges ,32.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,67.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,32.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.92,24,,,percent of total billed charges,24% of total billed charges ,41.5,31.2,,,percent of total billed charges,31.2% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,31.92,24,,,percent of total billed charges,24% of total billed charges ,31.92,24,,,percent of total billed charges,24% of total billed charges ,31.92,106.4,
TRANSFUSION REACTION WORKUP,4119839,CDM,300,RC,86078,HCPCS,Outpatient,,,913.5,456.75,,45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,219.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,730.8,80,,,percent of total billed charges,80% of total billed charges ,221.43,24.24,,,percent of total billed charges,24.24% of total billed charges ,460.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,685.13,75,,,percent of total billed charges,75% of total billed charges ,223.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,219.24,24,,,percent of total billed charges,24% of total billed charges ,285.01,31.2,,,percent of total billed charges,31.2% of total billed charges,730.8,80,,,percent of total billed charges,80% of total billed charges,219.24,24,,,percent of total billed charges,24% of total billed charges ,219.24,24,,,percent of total billed charges,24% of total billed charges ,45,730.8,
SUSCEPTIBILITY PANEL MIC,4119840,CDM,300,RC,87186,HCPCS,Outpatient,,,119.5,59.75,,10.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,10.87,95.6,
HEP C VIRUS FIBROSURE,4119841,CDM,300,RC,81599,HCPCS,Outpatient,,,346,173,,92.94,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,83.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,276.8,80,,,percent of total billed charges,80% of total billed charges ,83.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,174.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,259.5,75,,,percent of total billed charges,75% of total billed charges ,84.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,92.94,26.86,,,percent of total billed charges,26.86% of total billed charges,83.04,24,,,percent of total billed charges,24% of total billed charges ,107.95,31.2,,,percent of total billed charges,31.2% of total billed charges,276.8,80,,,percent of total billed charges,80% of total billed charges,83.04,24,,,percent of total billed charges,24% of total billed charges ,83.04,24,,,percent of total billed charges,24% of total billed charges ,83.04,276.8,
STREP PNEUMONIAE IGG - 14 SEROTYPES,4119842,CDM,300,RC,86317,HCPCS,Outpatient,,,489.5,244.75,,15.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,367.13,75,,,percent of total billed charges,75% of total billed charges ,367.13,75,,,percent of total billed charges,75% of total billed charges ,117.48,24,,,percent of total billed charges,24% of total billed charges ,367.13,75,,,percent of total billed charges,75% of total billed charges ,367.13,75,,,percent of total billed charges,75% of total billed charges ,391.6,80,,,percent of total billed charges,80% of total billed charges ,118.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,246.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,367.13,75,,,percent of total billed charges,75% of total billed charges ,119.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,117.48,24,,,percent of total billed charges,24% of total billed charges ,152.72,31.2,,,percent of total billed charges,31.2% of total billed charges,391.6,80,,,percent of total billed charges,80% of total billed charges,117.48,24,,,percent of total billed charges,24% of total billed charges ,117.48,24,,,percent of total billed charges,24% of total billed charges ,15.09,391.6,
HEP B GENOTYPE,4119843,CDM,300,RC,87912,HCPCS,Outpatient,,,948.5,474.25,,95.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,227.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,758.8,80,,,percent of total billed charges,80% of total billed charges ,229.92,24.24,,,percent of total billed charges,24.24% of total billed charges ,478.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,711.38,75,,,percent of total billed charges,75% of total billed charges ,232.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,227.64,24,,,percent of total billed charges,24% of total billed charges ,295.93,31.2,,,percent of total billed charges,31.2% of total billed charges,758.8,80,,,percent of total billed charges,80% of total billed charges,227.64,24,,,percent of total billed charges,24% of total billed charges ,227.64,24,,,percent of total billed charges,24% of total billed charges ,95.9,758.8,
CHLAMYDIA  ANTIBODY PANEL,4119844,CDM,300,RC,86631,HCPCS,Outpatient,,,166,83,,14.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,14.87,132.8,
C DIFF CONFIRMATION TEST,4119845,CDM,300,RC,87324,HCPCS,Outpatient,,,265.5,132.75,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,63.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,212.4,80,,,percent of total billed charges,80% of total billed charges ,64.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,133.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,64.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.72,24,,,percent of total billed charges,24% of total billed charges ,82.84,31.2,,,percent of total billed charges,31.2% of total billed charges,212.4,80,,,percent of total billed charges,80% of total billed charges,63.72,24,,,percent of total billed charges,24% of total billed charges ,63.72,24,,,percent of total billed charges,24% of total billed charges ,15.08,212.4,
WESTERN EQUINE ENCEPHALITIS VIRUS PANEL,4119846,CDM,300,RC,86654,HCPCS,Outpatient,,,772.5,386.25,,16.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,618,80,,,percent of total billed charges,80% of total billed charges ,187.25,24.24,,,percent of total billed charges,24.24% of total billed charges ,389.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,579.38,75,,,percent of total billed charges,75% of total billed charges ,189.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.4,24,,,percent of total billed charges,24% of total billed charges ,241.02,31.2,,,percent of total billed charges,31.2% of total billed charges,618,80,,,percent of total billed charges,80% of total billed charges,185.4,24,,,percent of total billed charges,24% of total billed charges ,185.4,24,,,percent of total billed charges,24% of total billed charges ,16.59,618,
AMIODARONE,4119848,CDM,301,RC,80151,HCPCS,Outpatient,,,297.5,148.75,,14.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,238,80,,,percent of total billed charges,80% of total billed charges ,72.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,149.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,72.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,24,,,percent of total billed charges,24% of total billed charges ,92.82,31.2,,,percent of total billed charges,31.2% of total billed charges,238,80,,,percent of total billed charges,80% of total billed charges,71.4,24,,,percent of total billed charges,24% of total billed charges ,71.4,24,,,percent of total billed charges,24% of total billed charges ,14.91,238,
SARS CoV-2 IgG (CCH),4119849,CDM,301,RC,86769,HCPCS,Outpatient,,,196.5,98.25,,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,147.38,75,,,percent of total billed charges,75% of total billed charges ,147.38,75,,,percent of total billed charges,75% of total billed charges ,47.16,24,,,percent of total billed charges,24% of total billed charges ,147.38,75,,,percent of total billed charges,75% of total billed charges ,147.38,75,,,percent of total billed charges,75% of total billed charges ,157.2,80,,,percent of total billed charges,80% of total billed charges ,47.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,99.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,147.38,75,,,percent of total billed charges,75% of total billed charges ,48.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.16,24,,,percent of total billed charges,24% of total billed charges ,61.31,31.2,,,percent of total billed charges,31.2% of total billed charges,157.2,80,,,percent of total billed charges,80% of total billed charges,47.16,24,,,percent of total billed charges,24% of total billed charges ,47.16,24,,,percent of total billed charges,24% of total billed charges ,47.16,157.2,
"NEUTROPHIL FUNCTION, OXIDATIVE BURST",4119851,CDM,300,RC,82657,HCPCS,Outpatient,,,419,209.5,,7.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,100.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,335.2,80,,,percent of total billed charges,80% of total billed charges ,101.57,24.24,,,percent of total billed charges,24.24% of total billed charges ,211.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,314.25,75,,,percent of total billed charges,75% of total billed charges ,102.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,100.56,24,,,percent of total billed charges,24% of total billed charges ,130.73,31.2,,,percent of total billed charges,31.2% of total billed charges,335.2,80,,,percent of total billed charges,80% of total billed charges,100.56,24,,,percent of total billed charges,24% of total billed charges ,100.56,24,,,percent of total billed charges,24% of total billed charges ,7.55,335.2,
SARS CoV2 ANTIGEN - DODGE COUNTY,4119852,CDM,301,RC,87426,HCPCS,Outpatient,,,227.5,113.75,,36.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,170.63,75,,,percent of total billed charges,75% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,54.6,24,,,percent of total billed charges,24% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,182,80,,,percent of total billed charges,80% of total billed charges ,55.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,114.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,55.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.6,24,,,percent of total billed charges,24% of total billed charges ,70.98,31.2,,,percent of total billed charges,31.2% of total billed charges,182,80,,,percent of total billed charges,80% of total billed charges,54.6,24,,,percent of total billed charges,24% of total billed charges ,54.6,24,,,percent of total billed charges,24% of total billed charges ,36.18,182,
H PYLORI CULTURE & SENSITIVITY,4119853,CDM,300,RC,87081,HCPCS,Outpatient,,,175,87.5,,8.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,140,80,,,percent of total billed charges,80% of total billed charges ,42.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,88.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,131.25,75,,,percent of total billed charges,75% of total billed charges ,42.84,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42,24,,,percent of total billed charges,24% of total billed charges ,54.6,31.2,,,percent of total billed charges,31.2% of total billed charges,140,80,,,percent of total billed charges,80% of total billed charges,42,24,,,percent of total billed charges,24% of total billed charges ,42,24,,,percent of total billed charges,24% of total billed charges ,8.33,140,
"CREATININE, PERITONEAL FLUID",4119854,CDM,300,RC,82570,HCPCS,Outpatient,,,45.5,22.75,,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.13,75,,,percent of total billed charges,75% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,36.4,80,,,percent of total billed charges,80% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,6.51,36.4,
"LD, PERITONEAL FLUID",4119855,CDM,300,RC,83615,HCPCS,Outpatient,,,295.5,147.75,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,70.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,236.4,80,,,percent of total billed charges,80% of total billed charges ,71.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,148.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,221.63,75,,,percent of total billed charges,75% of total billed charges ,72.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,70.92,24,,,percent of total billed charges,24% of total billed charges ,92.2,31.2,,,percent of total billed charges,31.2% of total billed charges,236.4,80,,,percent of total billed charges,80% of total billed charges,70.92,24,,,percent of total billed charges,24% of total billed charges ,70.92,24,,,percent of total billed charges,24% of total billed charges ,6.35,236.4,
PATH LEVEL III - 88304-TC,4119856,CDM,310,RC,88304,HCPCS,Outpatient,,,318.5,159.25,,30.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,254.8,80,,,percent of total billed charges,80% of total billed charges ,77.2,24.24,,,percent of total billed charges,24.24% of total billed charges ,160.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,77.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,76.44,24,,,percent of total billed charges,24% of total billed charges ,99.37,31.2,,,percent of total billed charges,31.2% of total billed charges,254.8,80,,,percent of total billed charges,80% of total billed charges,76.44,24,,,percent of total billed charges,24% of total billed charges ,76.44,24,,,percent of total billed charges,24% of total billed charges ,30.18,254.8,
PATH LEVEL IV TECH CHG  - 88305-TC,4119857,CDM,310,RC,88305,HCPCS,Outpatient,,,350,175,,65.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,280,80,,,percent of total billed charges,80% of total billed charges ,84.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,176.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,262.5,75,,,percent of total billed charges,75% of total billed charges ,85.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,65.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,84,24,,,percent of total billed charges,24% of total billed charges ,109.2,31.2,,,percent of total billed charges,31.2% of total billed charges,280,80,,,percent of total billed charges,80% of total billed charges,84,24,,,percent of total billed charges,24% of total billed charges ,84,24,,,percent of total billed charges,24% of total billed charges ,65.88,280,
THIOPURINE METABOLITES,4119858,CDM,300,RC,80299,HCPCS,Outpatient,,,512,256,,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,122.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,409.6,80,,,percent of total billed charges,80% of total billed charges ,124.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,258.05,50.4,,,percent of total billed charges,50.4% of total billed charges ,384,75,,,percent of total billed charges,75% of total billed charges ,125.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,122.88,24,,,percent of total billed charges,24% of total billed charges ,159.74,31.2,,,percent of total billed charges,31.2% of total billed charges,409.6,80,,,percent of total billed charges,80% of total billed charges,122.88,24,,,percent of total billed charges,24% of total billed charges ,122.88,24,,,percent of total billed charges,24% of total billed charges ,15.14,409.6,
SARS COV2 MOLECULAR- CCH,4119859,CDM,300,RC,87635,HCPCS,Outpatient,,,333.5,166.75,,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,250.13,75,,,percent of total billed charges,75% of total billed charges ,250.13,75,,,percent of total billed charges,75% of total billed charges ,80.04,24,,,percent of total billed charges,24% of total billed charges ,250.13,75,,,percent of total billed charges,75% of total billed charges ,250.13,75,,,percent of total billed charges,75% of total billed charges ,266.8,80,,,percent of total billed charges,80% of total billed charges ,80.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,168.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,250.13,75,,,percent of total billed charges,75% of total billed charges ,81.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,80.04,24,,,percent of total billed charges,24% of total billed charges ,104.05,31.2,,,percent of total billed charges,31.2% of total billed charges,266.8,80,,,percent of total billed charges,80% of total billed charges,80.04,24,,,percent of total billed charges,24% of total billed charges ,80.04,24,,,percent of total billed charges,24% of total billed charges ,51.31,266.8,
COVID ANTIGEN - CCH,4119860,CDM,300,RC,87426,HCPCS,Outpatient,,,244,122,,36.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,183,75,,,percent of total billed charges,75% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,58.56,24,,,percent of total billed charges,24% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,195.2,80,,,percent of total billed charges,80% of total billed charges ,59.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,122.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,59.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,58.56,24,,,percent of total billed charges,24% of total billed charges ,76.13,31.2,,,percent of total billed charges,31.2% of total billed charges,195.2,80,,,percent of total billed charges,80% of total billed charges,58.56,24,,,percent of total billed charges,24% of total billed charges ,58.56,24,,,percent of total billed charges,24% of total billed charges ,36.18,195.2,
CRP (INFLAMMATION),4119861,CDM,300,RC,86141,HCPCS,Outpatient,,,114.5,57.25,,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,16.28,91.6,
PATH IMMUNO HISTOCHEMISTRY 88342- TC,4119862,CDM,312,RC,88342,HCPCS,Outpatient,,,185.5,92.75,,71.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,44.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,148.4,80,,,percent of total billed charges,80% of total billed charges ,44.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,93.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,139.13,75,,,percent of total billed charges,75% of total billed charges ,45.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,71.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,44.52,24,,,percent of total billed charges,24% of total billed charges ,57.88,31.2,,,percent of total billed charges,31.2% of total billed charges,148.4,80,,,percent of total billed charges,80% of total billed charges,44.52,24,,,percent of total billed charges,24% of total billed charges ,44.52,24,,,percent of total billed charges,24% of total billed charges ,44.52,148.4,
PATHOLOGY - ABY STAINS - 88341 TC,4119863,CDM,312,RC,88341,HCPCS,Outpatient,,,185.5,92.75,,57.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,44.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,148.4,80,,,percent of total billed charges,80% of total billed charges ,44.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,93.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,139.13,75,,,percent of total billed charges,75% of total billed charges ,45.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,57.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,44.52,24,,,percent of total billed charges,24% of total billed charges ,57.88,31.2,,,percent of total billed charges,31.2% of total billed charges,148.4,80,,,percent of total billed charges,80% of total billed charges,44.52,24,,,percent of total billed charges,24% of total billed charges ,44.52,24,,,percent of total billed charges,24% of total billed charges ,44.52,148.4,
"CD-19 B CELL, TOTAL",4119865,CDM,300,RC,86355,HCPCS,Outpatient,,,207,103.5,,29.62,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,155.25,75,,,percent of total billed charges,75% of total billed charges ,155.25,75,,,percent of total billed charges,75% of total billed charges ,49.68,24,,,percent of total billed charges,24% of total billed charges ,155.25,75,,,percent of total billed charges,75% of total billed charges ,155.25,75,,,percent of total billed charges,75% of total billed charges ,165.6,80,,,percent of total billed charges,80% of total billed charges ,50.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,104.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,155.25,75,,,percent of total billed charges,75% of total billed charges ,50.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.62,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,49.68,24,,,percent of total billed charges,24% of total billed charges ,64.58,31.2,,,percent of total billed charges,31.2% of total billed charges,165.6,80,,,percent of total billed charges,80% of total billed charges,49.68,24,,,percent of total billed charges,24% of total billed charges ,49.68,24,,,percent of total billed charges,24% of total billed charges ,29.62,165.6,
"NATURAL KILLER CELL COUNT, TOTAL",4119866,CDM,300,RC,86357,HCPCS,Outpatient,,,207,103.5,,29.62,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,155.25,75,,,percent of total billed charges,75% of total billed charges ,155.25,75,,,percent of total billed charges,75% of total billed charges ,49.68,24,,,percent of total billed charges,24% of total billed charges ,155.25,75,,,percent of total billed charges,75% of total billed charges ,155.25,75,,,percent of total billed charges,75% of total billed charges ,165.6,80,,,percent of total billed charges,80% of total billed charges ,50.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,104.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,155.25,75,,,percent of total billed charges,75% of total billed charges ,50.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.62,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,49.68,24,,,percent of total billed charges,24% of total billed charges ,64.58,31.2,,,percent of total billed charges,31.2% of total billed charges,165.6,80,,,percent of total billed charges,80% of total billed charges,49.68,24,,,percent of total billed charges,24% of total billed charges ,49.68,24,,,percent of total billed charges,24% of total billed charges ,29.62,165.6,
T CELL TOTAL COUNT,4119867,CDM,300,RC,86359,HCPCS,Outpatient,,,207,103.5,,29.62,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,155.25,75,,,percent of total billed charges,75% of total billed charges ,155.25,75,,,percent of total billed charges,75% of total billed charges ,49.68,24,,,percent of total billed charges,24% of total billed charges ,155.25,75,,,percent of total billed charges,75% of total billed charges ,155.25,75,,,percent of total billed charges,75% of total billed charges ,165.6,80,,,percent of total billed charges,80% of total billed charges ,50.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,104.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,155.25,75,,,percent of total billed charges,75% of total billed charges ,50.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.62,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,49.68,24,,,percent of total billed charges,24% of total billed charges ,64.58,31.2,,,percent of total billed charges,31.2% of total billed charges,165.6,80,,,percent of total billed charges,80% of total billed charges,49.68,24,,,percent of total billed charges,24% of total billed charges ,49.68,24,,,percent of total billed charges,24% of total billed charges ,29.62,165.6,
T CELL ABSOLUTE CT,4119868,CDM,300,RC,86360,HCPCS,Outpatient,,,313,156.5,,59.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,234.75,75,,,percent of total billed charges,75% of total billed charges ,234.75,75,,,percent of total billed charges,75% of total billed charges ,75.12,24,,,percent of total billed charges,24% of total billed charges ,234.75,75,,,percent of total billed charges,75% of total billed charges ,234.75,75,,,percent of total billed charges,75% of total billed charges ,250.4,80,,,percent of total billed charges,80% of total billed charges ,75.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,157.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,234.75,75,,,percent of total billed charges,75% of total billed charges ,76.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,75.12,24,,,percent of total billed charges,24% of total billed charges ,97.66,31.2,,,percent of total billed charges,31.2% of total billed charges,250.4,80,,,percent of total billed charges,80% of total billed charges,75.12,24,,,percent of total billed charges,24% of total billed charges ,75.12,24,,,percent of total billed charges,24% of total billed charges ,59.09,250.4,
ADALIMUMAB DRUG ANTIBODY,4119870,CDM,301,RC,83520,HCPCS,Outpatient,,,981.5,490.75,,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,235.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,785.2,80,,,percent of total billed charges,80% of total billed charges ,237.92,24.24,,,percent of total billed charges,24.24% of total billed charges ,494.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,736.13,75,,,percent of total billed charges,75% of total billed charges ,240.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,235.56,24,,,percent of total billed charges,24% of total billed charges ,306.23,31.2,,,percent of total billed charges,31.2% of total billed charges,785.2,80,,,percent of total billed charges,80% of total billed charges,235.56,24,,,percent of total billed charges,24% of total billed charges ,235.56,24,,,percent of total billed charges,24% of total billed charges ,16.28,785.2,
"TRIGLYCERIDES, PERITONEAL FLUID",4119871,CDM,300,RC,84478,HCPCS,Outpatient,,,45.5,22.75,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.13,75,,,percent of total billed charges,75% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,36.4,80,,,percent of total billed charges,80% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,6.35,36.4,
"CHOLESTEROL, PERITONEAL FLUID",4119872,CDM,300,RC,84311,HCPCS,Outpatient,,,45.5,22.75,,8.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,36.4,80,,,percent of total billed charges,80% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,8.79,36.4,
"SPECIFIC GRAVITY, BODY FLUID",4119873,CDM,300,RC,84315,HCPCS,Outpatient,,,45.5,22.75,,3.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,36.4,80,,,percent of total billed charges,80% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,3.15,36.4,
"AMYLASE, PERITONEAL FLUID",4119874,CDM,300,RC,82150,HCPCS,Outpatient,,,58.5,29.25,,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,43.88,75,,,percent of total billed charges,75% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,8.15,46.8,
"LIPASE, PLEURAL FLUID",4119875,CDM,300,RC,83690,HCPCS,Outpatient,,,58.5,29.25,,8.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,8.66,46.8,
PATH LEVEL III SURG - 88304 TC,4119876,CDM,310,RC,88304,HCPCS,Outpatient,,,221.5,110.75,,30.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,177.2,80,,,percent of total billed charges,80% of total billed charges ,53.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,111.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,166.13,75,,,percent of total billed charges,75% of total billed charges ,54.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,53.16,24,,,percent of total billed charges,24% of total billed charges ,69.11,31.2,,,percent of total billed charges,31.2% of total billed charges,177.2,80,,,percent of total billed charges,80% of total billed charges,53.16,24,,,percent of total billed charges,24% of total billed charges ,53.16,24,,,percent of total billed charges,24% of total billed charges ,30.18,177.2,
"CORTISOL, SALIVA",4119877,CDM,301,RC,82530,HCPCS,Outpatient,,,419,209.5,,21.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,100.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,335.2,80,,,percent of total billed charges,80% of total billed charges ,101.57,24.24,,,percent of total billed charges,24.24% of total billed charges ,211.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,314.25,75,,,percent of total billed charges,75% of total billed charges ,102.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,100.56,24,,,percent of total billed charges,24% of total billed charges ,130.73,31.2,,,percent of total billed charges,31.2% of total billed charges,335.2,80,,,percent of total billed charges,80% of total billed charges,100.56,24,,,percent of total billed charges,24% of total billed charges ,100.56,24,,,percent of total billed charges,24% of total billed charges ,21.02,335.2,
SARS COV2 MOLECULAR W/ REFLEX TO PCR,4119879,CDM,300,RC,87635,HCPCS,Outpatient,,,333.5,166.75,,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,250.13,75,,,percent of total billed charges,75% of total billed charges ,250.13,75,,,percent of total billed charges,75% of total billed charges ,80.04,24,,,percent of total billed charges,24% of total billed charges ,250.13,75,,,percent of total billed charges,75% of total billed charges ,250.13,75,,,percent of total billed charges,75% of total billed charges ,266.8,80,,,percent of total billed charges,80% of total billed charges ,80.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,168.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,250.13,75,,,percent of total billed charges,75% of total billed charges ,81.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,80.04,24,,,percent of total billed charges,24% of total billed charges ,104.05,31.2,,,percent of total billed charges,31.2% of total billed charges,266.8,80,,,percent of total billed charges,80% of total billed charges,80.04,24,,,percent of total billed charges,24% of total billed charges ,80.04,24,,,percent of total billed charges,24% of total billed charges ,51.31,266.8,
ADRENAL ANTIBODY SCREEN,4119888,CDM,300,RC,86255,HCPCS,Outpatient,,,236,118,,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,188.8,80,,,percent of total billed charges,80% of total billed charges ,57.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,118.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,177,75,,,percent of total billed charges,75% of total billed charges ,57.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.64,24,,,percent of total billed charges,24% of total billed charges ,73.63,31.2,,,percent of total billed charges,31.2% of total billed charges,188.8,80,,,percent of total billed charges,80% of total billed charges,56.64,24,,,percent of total billed charges,24% of total billed charges ,56.64,24,,,percent of total billed charges,24% of total billed charges ,15.16,188.8,
"ALBUMIN, PERITONEAL FLUID",4119889,CDM,300,RC,82042,HCPCS,Outpatient,,,37,18.5,,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,6.51,29.6,
PATH STAIN GROUP 1 -88312-TC,4119890,CDM,312,RC,88312,HCPCS,Outpatient,,,302,151,,43.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,72.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,241.6,80,,,percent of total billed charges,80% of total billed charges ,73.2,24.24,,,percent of total billed charges,24.24% of total billed charges ,152.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,226.5,75,,,percent of total billed charges,75% of total billed charges ,73.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,43.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,72.48,24,,,percent of total billed charges,24% of total billed charges ,94.22,31.2,,,percent of total billed charges,31.2% of total billed charges,241.6,80,,,percent of total billed charges,80% of total billed charges,72.48,24,,,percent of total billed charges,24% of total billed charges ,72.48,24,,,percent of total billed charges,24% of total billed charges ,43.39,241.6,
Troponin I - HS,4119891,CDM,301,RC,84484,HCPCS,Outpatient,,,342,171,,12.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,82.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,273.6,80,,,percent of total billed charges,80% of total billed charges ,82.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,172.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,256.5,75,,,percent of total billed charges,75% of total billed charges ,83.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,82.08,24,,,percent of total billed charges,24% of total billed charges ,106.7,31.2,,,percent of total billed charges,31.2% of total billed charges,273.6,80,,,percent of total billed charges,80% of total billed charges,82.08,24,,,percent of total billed charges,24% of total billed charges ,82.08,24,,,percent of total billed charges,24% of total billed charges ,12.38,273.6,
TRYPANOSOMA CRUZI ABY,4119892,CDM,300,RC,86753,HCPCS,Outpatient,,,483,241.5,,15.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,362.25,75,,,percent of total billed charges,75% of total billed charges ,362.25,75,,,percent of total billed charges,75% of total billed charges ,115.92,24,,,percent of total billed charges,24% of total billed charges ,362.25,75,,,percent of total billed charges,75% of total billed charges ,362.25,75,,,percent of total billed charges,75% of total billed charges ,386.4,80,,,percent of total billed charges,80% of total billed charges ,117.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,243.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,362.25,75,,,percent of total billed charges,75% of total billed charges ,118.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,115.92,24,,,percent of total billed charges,24% of total billed charges ,150.7,31.2,,,percent of total billed charges,31.2% of total billed charges,386.4,80,,,percent of total billed charges,80% of total billed charges,115.92,24,,,percent of total billed charges,24% of total billed charges ,115.92,24,,,percent of total billed charges,24% of total billed charges ,15.59,386.4,
HCV RNA QUANT PCR WITH REFLEX TO GENO,4119893,CDM,300,RC,87522,HCPCS,Outpatient,,,497.5,248.75,,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,373.13,75,,,percent of total billed charges,75% of total billed charges ,373.13,75,,,percent of total billed charges,75% of total billed charges ,119.4,24,,,percent of total billed charges,24% of total billed charges ,373.13,75,,,percent of total billed charges,75% of total billed charges ,373.13,75,,,percent of total billed charges,75% of total billed charges ,398,80,,,percent of total billed charges,80% of total billed charges ,120.59,24.24,,,percent of total billed charges,24.24% of total billed charges ,250.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,373.13,75,,,percent of total billed charges,75% of total billed charges ,121.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,119.4,24,,,percent of total billed charges,24% of total billed charges ,155.22,31.2,,,percent of total billed charges,31.2% of total billed charges,398,80,,,percent of total billed charges,80% of total billed charges,119.4,24,,,percent of total billed charges,24% of total billed charges ,119.4,24,,,percent of total billed charges,24% of total billed charges ,53.87,398,
MuSK ANTIBODY,4119894,CDM,300,RC,83519,HCPCS,Outpatient,,,4562,2281,,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1094.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3649.6,80,,,percent of total billed charges,80% of total billed charges ,1105.83,24.24,,,percent of total billed charges,24.24% of total billed charges ,2299.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,3421.5,75,,,percent of total billed charges,75% of total billed charges ,1116.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,1094.88,24,,,percent of total billed charges,24% of total billed charges ,1423.34,31.2,,,percent of total billed charges,31.2% of total billed charges,3649.6,80,,,percent of total billed charges,80% of total billed charges,1094.88,24,,,percent of total billed charges,24% of total billed charges ,1094.88,24,,,percent of total billed charges,24% of total billed charges ,16.99,3649.6,
ACTIVATED PROTEIN C RESISTANCE,4119895,CDM,300,RC,85307,HCPCS,Outpatient,,,254.5,127.25,,19.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,203.6,80,,,percent of total billed charges,80% of total billed charges ,61.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,128.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,190.88,75,,,percent of total billed charges,75% of total billed charges ,62.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.08,24,,,percent of total billed charges,24% of total billed charges ,79.4,31.2,,,percent of total billed charges,31.2% of total billed charges,203.6,80,,,percent of total billed charges,80% of total billed charges,61.08,24,,,percent of total billed charges,24% of total billed charges ,61.08,24,,,percent of total billed charges,24% of total billed charges ,19.27,203.6,
"URINE CALCIUM, 24 hour",4119896,CDM,301,RC,82340,HCPCS,Outpatient,,,108,54,,7.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,7.59,86.4,
MPO ANTIBODY,4119897,CDM,300,RC,86021,HCPCS,Outpatient,,,166,83,,18.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,18.93,132.8,
PR3 ANTIBODY,4119898,CDM,300,RC,86021,HCPCS,Outpatient,,,166,83,,18.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,18.93,132.8,
PORK IGE RAST,4119899,CDM,300,RC,86003,HCPCS,Outpatient,,,59.5,29.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,6.57,47.6,
"CATECHOLAMINES, FRAC, 24 HR URINE",4119900,CDM,301,RC,82384,HCPCS,Outpatient,,,99,49.5,,31.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,79.2,80,,,percent of total billed charges,80% of total billed charges ,24,24.24,,,percent of total billed charges,24.24% of total billed charges ,49.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,74.25,75,,,percent of total billed charges,75% of total billed charges ,24.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.76,24,,,percent of total billed charges,24% of total billed charges ,30.89,31.2,,,percent of total billed charges,31.2% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,23.76,24,,,percent of total billed charges,24% of total billed charges ,23.76,24,,,percent of total billed charges,24% of total billed charges ,23.76,79.2,
BB RH BLOOD TYPE SHEPEARD,4119901,CDM,300,RC,86901,HCPCS,Outpatient,,,101,50.5,,14.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,14.51,80.8,
"LD, PLEURAL FLUID",4119902,CDM,300,RC,83615,HCPCS,Outpatient,,,295.5,147.75,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,70.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,236.4,80,,,percent of total billed charges,80% of total billed charges ,71.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,148.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,221.63,75,,,percent of total billed charges,75% of total billed charges ,72.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,70.92,24,,,percent of total billed charges,24% of total billed charges ,92.2,31.2,,,percent of total billed charges,31.2% of total billed charges,236.4,80,,,percent of total billed charges,80% of total billed charges,70.92,24,,,percent of total billed charges,24% of total billed charges ,70.92,24,,,percent of total billed charges,24% of total billed charges ,6.35,236.4,
BB SELECTED CELL SHEPEARD,4119903,CDM,300,RC,86885,HCPCS,Outpatient,,,143,71.5,,7.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,114.4,80,,,percent of total billed charges,80% of total billed charges ,34.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,35.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.32,24,,,percent of total billed charges,24% of total billed charges ,44.62,31.2,,,percent of total billed charges,31.2% of total billed charges,114.4,80,,,percent of total billed charges,80% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,7.19,114.4,
RPR TITER CHARGE,4119905,CDM,300,RC,86593,HCPCS,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
FLU  A & B MOLECULAR,4119906,CDM,300,RC,87502,HCPCS,Outpatient,,,133,66.5,,58.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,99.75,75,,,percent of total billed charges,75% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,31.92,24,,,percent of total billed charges,24% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,106.4,80,,,percent of total billed charges,80% of total billed charges ,32.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,67.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,32.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,58.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.92,24,,,percent of total billed charges,24% of total billed charges ,41.5,31.2,,,percent of total billed charges,31.2% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,31.92,24,,,percent of total billed charges,24% of total billed charges ,31.92,24,,,percent of total billed charges,24% of total billed charges ,31.92,106.4,
LP-PLA2 ACTIVITY,4119907,CDM,300,RC,83698,HCPCS,Outpatient,,,164,82,,42.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,131.2,80,,,percent of total billed charges,80% of total billed charges ,39.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,82.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,123,75,,,percent of total billed charges,75% of total billed charges ,40.15,24.48,,,percent of total billed charges,24.48% of total billed charges ,42.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.36,24,,,percent of total billed charges,24% of total billed charges ,51.17,31.2,,,percent of total billed charges,31.2% of total billed charges,131.2,80,,,percent of total billed charges,80% of total billed charges,39.36,24,,,percent of total billed charges,24% of total billed charges ,39.36,24,,,percent of total billed charges,24% of total billed charges ,39.36,131.2,
STREP A - MOLECULAR,4119908,CDM,300,RC,87651,HCPCS,Outpatient,,,85.5,42.75,,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,64.13,75,,,percent of total billed charges,75% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,20.52,24,,,percent of total billed charges,24% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,68.4,80,,,percent of total billed charges,80% of total billed charges ,20.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,43.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,20.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.52,24,,,percent of total billed charges,24% of total billed charges ,26.68,31.2,,,percent of total billed charges,31.2% of total billed charges,68.4,80,,,percent of total billed charges,80% of total billed charges,20.52,24,,,percent of total billed charges,24% of total billed charges ,20.52,24,,,percent of total billed charges,24% of total billed charges ,20.52,68.4,
B PERTUSSIS IGM AB,4119909,CDM,300,RC,86615,HCPCS,Outpatient,,,139,69.5,,16.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,111.2,80,,,percent of total billed charges,80% of total billed charges ,33.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,70.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,104.25,75,,,percent of total billed charges,75% of total billed charges ,34.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.36,24,,,percent of total billed charges,24% of total billed charges ,43.37,31.2,,,percent of total billed charges,31.2% of total billed charges,111.2,80,,,percent of total billed charges,80% of total billed charges,33.36,24,,,percent of total billed charges,24% of total billed charges ,33.36,24,,,percent of total billed charges,24% of total billed charges ,16.59,111.2,
RSV - MOLECULAR,4119910,CDM,300,RC,87634,HCPCS,Outpatient,,,133,66.5,,69.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,99.75,75,,,percent of total billed charges,75% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,31.92,24,,,percent of total billed charges,24% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,106.4,80,,,percent of total billed charges,80% of total billed charges ,32.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,67.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,32.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,69.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.92,24,,,percent of total billed charges,24% of total billed charges ,41.5,31.2,,,percent of total billed charges,31.2% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,31.92,24,,,percent of total billed charges,24% of total billed charges ,31.92,24,,,percent of total billed charges,24% of total billed charges ,31.92,106.4,
IHC ANTIBODY STAIN - 88344 TC,4119911,CDM,312,RC,88344,HCPCS,Outpatient,,,135,67.5,,99.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,108,80,,,percent of total billed charges,80% of total billed charges ,32.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,101.25,75,,,percent of total billed charges,75% of total billed charges ,33.05,24.48,,,percent of total billed charges,24.48% of total billed charges ,99.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,32.4,24,,,percent of total billed charges,24% of total billed charges ,42.12,31.2,,,percent of total billed charges,31.2% of total billed charges,108,80,,,percent of total billed charges,80% of total billed charges,32.4,24,,,percent of total billed charges,24% of total billed charges ,32.4,24,,,percent of total billed charges,24% of total billed charges ,32.4,108,
HUMAN TRANSFORMING GROWTH FACTOR,4119912,CDM,300,RC,83520,HCPCS,Outpatient,,,139,69.5,,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,111.2,80,,,percent of total billed charges,80% of total billed charges ,33.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,70.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,104.25,75,,,percent of total billed charges,75% of total billed charges ,34.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.36,24,,,percent of total billed charges,24% of total billed charges ,43.37,31.2,,,percent of total billed charges,31.2% of total billed charges,111.2,80,,,percent of total billed charges,80% of total billed charges,33.36,24,,,percent of total billed charges,24% of total billed charges ,33.36,24,,,percent of total billed charges,24% of total billed charges ,16.28,111.2,
PATH LEVEL II SURG  - 88302-TC,4119913,CDM,310,RC,88302,HCPCS,Outpatient,,,135.5,67.75,,35.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,108.4,80,,,percent of total billed charges,80% of total billed charges ,32.85,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,101.63,75,,,percent of total billed charges,75% of total billed charges ,33.17,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,32.52,24,,,percent of total billed charges,24% of total billed charges ,42.28,31.2,,,percent of total billed charges,31.2% of total billed charges,108.4,80,,,percent of total billed charges,80% of total billed charges,32.52,24,,,percent of total billed charges,24% of total billed charges ,32.52,24,,,percent of total billed charges,24% of total billed charges ,32.52,108.4,
CBC W/DIFF - DxH 520,4119914,CDM,300,RC,85025,HCPCS,Outpatient,,,144,72,,9.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,115.2,80,,,percent of total billed charges,80% of total billed charges ,34.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,35.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.56,24,,,percent of total billed charges,24% of total billed charges ,44.93,31.2,,,percent of total billed charges,31.2% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,9.77,115.2,
ELECTROLYTES - EPOC,4119915,CDM,301,RC,80051,HCPCS,Outpatient,,,166,83,,8.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,8.82,132.8,
HSV 1 DNA QUAL BY PCR,4119916,CDM,300,RC,87529,HCPCS,Outpatient,,,138,69,,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,103.5,75,,,percent of total billed charges,75% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,33.12,24,,,percent of total billed charges,24% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,110.4,80,,,percent of total billed charges,80% of total billed charges ,33.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,69.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,33.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.12,24,,,percent of total billed charges,24% of total billed charges ,43.06,31.2,,,percent of total billed charges,31.2% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,33.12,24,,,percent of total billed charges,24% of total billed charges ,33.12,24,,,percent of total billed charges,24% of total billed charges ,24.67,110.4,
HSV 2 DNA QUAL BY PCR,4119917,CDM,300,RC,87529,HCPCS,Outpatient,,,138,69,,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,103.5,75,,,percent of total billed charges,75% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,33.12,24,,,percent of total billed charges,24% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,110.4,80,,,percent of total billed charges,80% of total billed charges ,33.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,69.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,33.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.12,24,,,percent of total billed charges,24% of total billed charges ,43.06,31.2,,,percent of total billed charges,31.2% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,33.12,24,,,percent of total billed charges,24% of total billed charges ,33.12,24,,,percent of total billed charges,24% of total billed charges ,24.67,110.4,
C4a Level by RIA,4119919,CDM,300,RC,86160,HCPCS,Outpatient,,,159.5,79.75,,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,127.6,80,,,percent of total billed charges,80% of total billed charges ,38.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,80.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,119.63,75,,,percent of total billed charges,75% of total billed charges ,39.05,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,38.28,24,,,percent of total billed charges,24% of total billed charges ,49.76,31.2,,,percent of total billed charges,31.2% of total billed charges,127.6,80,,,percent of total billed charges,80% of total billed charges,38.28,24,,,percent of total billed charges,24% of total billed charges ,38.28,24,,,percent of total billed charges,24% of total billed charges ,15.1,127.6,
PATH LEVEL V TECH CHG  - 88307-TC,4119920,CDM,310,RC,88307,HCPCS,Outpatient,,,350,175,,133.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,280,80,,,percent of total billed charges,80% of total billed charges ,84.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,176.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,262.5,75,,,percent of total billed charges,75% of total billed charges ,85.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,133.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,84,24,,,percent of total billed charges,24% of total billed charges ,109.2,31.2,,,percent of total billed charges,31.2% of total billed charges,280,80,,,percent of total billed charges,80% of total billed charges,84,24,,,percent of total billed charges,24% of total billed charges ,84,24,,,percent of total billed charges,24% of total billed charges ,84,280,
PATH SPECIAL STAINS GROUP 2 - 88313 TC,4119922,CDM,312,RC,88313,HCPCS,Outpatient,,,109,54.5,,44.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,87.2,80,,,percent of total billed charges,80% of total billed charges ,26.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,26.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,44.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.16,24,,,percent of total billed charges,24% of total billed charges ,34.01,31.2,,,percent of total billed charges,31.2% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,26.16,24,,,percent of total billed charges,24% of total billed charges ,26.16,24,,,percent of total billed charges,24% of total billed charges ,26.16,87.2,
CREATININE - EPOC,4119923,CDM,301,RC,82565,HCPCS,Outpatient,,,18.5,9.25,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
"INSULIN, 2 HOUR",4119924,CDM,300,RC,83525,HCPCS,Outpatient,,,180.5,90.25,,14.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,43.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,144.4,80,,,percent of total billed charges,80% of total billed charges ,43.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,90.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,44.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,43.32,24,,,percent of total billed charges,24% of total billed charges ,56.32,31.2,,,percent of total billed charges,31.2% of total billed charges,144.4,80,,,percent of total billed charges,80% of total billed charges,43.32,24,,,percent of total billed charges,24% of total billed charges ,43.32,24,,,percent of total billed charges,24% of total billed charges ,14.38,144.4,
"ALBUMIN, PLEURAL FLUID",4119925,CDM,300,RC,82042,HCPCS,Outpatient,,,37,18.5,,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,6.51,29.6,
"AMYLASE, PLEURAL FLUID",4119926,CDM,300,RC,82150,HCPCS,Outpatient,,,58.5,29.25,,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,43.88,75,,,percent of total billed charges,75% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,8.15,46.8,
"CEA, PERITONEAL FLUID",4119927,CDM,301,RC,82378,HCPCS,Outpatient,,,214,107,,23.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,171.2,80,,,percent of total billed charges,80% of total billed charges ,51.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,52.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.36,24,,,percent of total billed charges,24% of total billed charges ,66.77,31.2,,,percent of total billed charges,31.2% of total billed charges,171.2,80,,,percent of total billed charges,80% of total billed charges,51.36,24,,,percent of total billed charges,24% of total billed charges ,51.36,24,,,percent of total billed charges,24% of total billed charges ,23.86,171.2,
"GLUCOSE, PERITONEAL FLUID",4119928,CDM,300,RC,82945,HCPCS,Outpatient,,,96,48,,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,4.93,76.8,
"GLUCOSE, PLEURAL FLUID",4119929,CDM,300,RC,82945,HCPCS,Outpatient,,,96,48,,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,4.93,76.8,
"TOTAL PROTEIN, PLEURAL FLUID",4119930,CDM,300,RC,84157,HCPCS,Outpatient,,,96,48,,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,4.61,76.8,
"TOTAL PROTEIN, PERITONEAL FLUID",4119931,CDM,300,RC,84157,HCPCS,Outpatient,,,96,48,,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,4.61,76.8,
"TOTAL PROTEIN, PERICARDIAL FLUID",4119932,CDM,300,RC,84157,HCPCS,Outpatient,,,96,48,,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,4.61,76.8,
"CHOLESTEROL, PLEURAL FLUID",4119933,CDM,300,RC,84311,HCPCS,Outpatient,,,45.5,22.75,,8.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,36.4,80,,,percent of total billed charges,80% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,8.79,36.4,
"TRIGLYCERIDES, PLEURAL FLUID",4119934,CDM,300,RC,84478,HCPCS,Outpatient,,,45.5,22.75,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.13,75,,,percent of total billed charges,75% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,36.4,80,,,percent of total billed charges,80% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,6.35,36.4,
"LIPASE, PERITONEAL FLUID",4119935,CDM,300,RC,83690,HCPCS,Outpatient,,,58.5,29.25,,8.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,8.66,46.8,
"GLUCOSE, PERICARDIAL FLUID",4119936,CDM,300,RC,82945,HCPCS,Outpatient,,,96,48,,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,4.93,76.8,
"DHEA, UNCONJUGATED",4119937,CDM,301,RC,82626,HCPCS,Outpatient,,,345,172.5,,31.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,82.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,276,80,,,percent of total billed charges,80% of total billed charges ,83.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,173.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,258.75,75,,,percent of total billed charges,75% of total billed charges ,84.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,82.8,24,,,percent of total billed charges,24% of total billed charges ,107.64,31.2,,,percent of total billed charges,31.2% of total billed charges,276,80,,,percent of total billed charges,80% of total billed charges,82.8,24,,,percent of total billed charges,24% of total billed charges ,82.8,24,,,percent of total billed charges,24% of total billed charges ,31.78,276,
"CELL COUNT, PLEURAL FLUID",4119938,CDM,300,RC,89051,HCPCS,Outpatient,,,72,36,,2.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,2.21,57.6,
COMPLEMENT C4,4119939,CDM,300,RC,86160,HCPCS,Outpatient,,,48.5,24.25,,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.8,80,,,percent of total billed charges,80% of total billed charges ,11.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.64,24,,,percent of total billed charges,24% of total billed charges ,15.13,31.2,,,percent of total billed charges,31.2% of total billed charges,38.8,80,,,percent of total billed charges,80% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,38.8,
"ESTRADIOL, FREE",4119940,CDM,301,RC,82670,HCPCS,Outpatient,,,188.5,94.25,,35.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.8,80,,,percent of total billed charges,80% of total billed charges ,45.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,95,50.4,,,percent of total billed charges,50.4% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,46.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.24,24,,,percent of total billed charges,24% of total billed charges ,58.81,31.2,,,percent of total billed charges,31.2% of total billed charges,150.8,80,,,percent of total billed charges,80% of total billed charges,45.24,24,,,percent of total billed charges,24% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,35.14,150.8,
HEPATITIS A  ABY W/ REFLEX TO IGM,4119941,CDM,300,RC,86708,HCPCS,Outpatient,,,59.5,29.75,,15.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,47.6,
MUMPS VIRUS IGM,4119942,CDM,300,RC,86735,HCPCS,Outpatient,,,91.5,45.75,,16.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.63,75,,,percent of total billed charges,75% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,21.96,24,,,percent of total billed charges,24% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,73.2,80,,,percent of total billed charges,80% of total billed charges ,22.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,46.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,22.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.96,24,,,percent of total billed charges,24% of total billed charges ,28.55,31.2,,,percent of total billed charges,31.2% of total billed charges,73.2,80,,,percent of total billed charges,80% of total billed charges,21.96,24,,,percent of total billed charges,24% of total billed charges ,21.96,24,,,percent of total billed charges,24% of total billed charges ,16.41,73.2,
IGF BINDING PROTEIN 1,4119943,CDM,300,RC,83519,HCPCS,Outpatient,,,114.5,57.25,,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,16.99,91.6,
BLOOD CULTURE - QUEST,4119944,CDM,300,RC,87040,HCPCS,Outpatient,,,72,36,,12.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,12.98,57.6,
AEROBIC CULTURE - QUEST,4119945,CDM,300,RC,87070,HCPCS,Outpatient,,,134,67,,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,107.2,80,,,percent of total billed charges,80% of total billed charges ,32.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,67.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,100.5,75,,,percent of total billed charges,75% of total billed charges ,32.8,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,32.16,24,,,percent of total billed charges,24% of total billed charges ,41.81,31.2,,,percent of total billed charges,31.2% of total billed charges,107.2,80,,,percent of total billed charges,80% of total billed charges,32.16,24,,,percent of total billed charges,24% of total billed charges ,32.16,24,,,percent of total billed charges,24% of total billed charges ,10.83,107.2,
"CEA, PANCREATIC CYST FLUID",4119946,CDM,301,RC,82378,HCPCS,Outpatient,,,214,107,,23.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,171.2,80,,,percent of total billed charges,80% of total billed charges ,51.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,160.5,75,,,percent of total billed charges,75% of total billed charges ,52.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.36,24,,,percent of total billed charges,24% of total billed charges ,66.77,31.2,,,percent of total billed charges,31.2% of total billed charges,171.2,80,,,percent of total billed charges,80% of total billed charges,51.36,24,,,percent of total billed charges,24% of total billed charges ,51.36,24,,,percent of total billed charges,24% of total billed charges ,23.86,171.2,
"CELL COUNT & DIFF, SYNOVIAL FLUID",4119947,CDM,300,RC,89051,HCPCS,Outpatient,,,72,36,,2.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,2.21,57.6,
"FUNGAL CX W/ SMEAR-NOT HAIR,SKIN,BLD",4119948,CDM,300,RC,87102,HCPCS,Outpatient,,,46.5,23.25,,10.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,10.57,37.2,
"CELL COUNT & DIFF, PERITONEAL FLUID",4119949,CDM,300,RC,89051,HCPCS,Outpatient,,,72,36,,2.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,2.21,57.6,
"TOTAL PROTEIN & CREAT., 24 HOUR URINE",4119950,CDM,300,RC,84156,HCPCS,Outpatient,,,108,54,,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,4.61,86.4,
"GRAM STAIN, QUEST",4119951,CDM,300,RC,87205,HCPCS,Outpatient,,,83.5,41.75,,2.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,2.95,66.8,
AEROBIC & ANAEROBIC CULTURE - QUEST,4119952,CDM,300,RC,87070,HCPCS,Outpatient,,,134,67,,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,107.2,80,,,percent of total billed charges,80% of total billed charges ,32.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,67.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,100.5,75,,,percent of total billed charges,75% of total billed charges ,32.8,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,32.16,24,,,percent of total billed charges,24% of total billed charges ,41.81,31.2,,,percent of total billed charges,31.2% of total billed charges,107.2,80,,,percent of total billed charges,80% of total billed charges,32.16,24,,,percent of total billed charges,24% of total billed charges ,32.16,24,,,percent of total billed charges,24% of total billed charges ,10.83,107.2,
RIBOSOMAL P ANTIBODY,4119953,CDM,300,RC,83516,HCPCS,Outpatient,,,123.5,61.75,,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,92.63,75,,,percent of total billed charges,75% of total billed charges ,92.63,75,,,percent of total billed charges,75% of total billed charges ,29.64,24,,,percent of total billed charges,24% of total billed charges ,92.63,75,,,percent of total billed charges,75% of total billed charges ,92.63,75,,,percent of total billed charges,75% of total billed charges ,98.8,80,,,percent of total billed charges,80% of total billed charges ,29.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,62.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,92.63,75,,,percent of total billed charges,75% of total billed charges ,30.23,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.64,24,,,percent of total billed charges,24% of total billed charges ,38.53,31.2,,,percent of total billed charges,31.2% of total billed charges,98.8,80,,,percent of total billed charges,80% of total billed charges,29.64,24,,,percent of total billed charges,24% of total billed charges ,29.64,24,,,percent of total billed charges,24% of total billed charges ,13.45,98.8,
PATH DECALCIFICATION TECH CHG - 88311TC,4119955,CDM,312,RC,88311,HCPCS,Outpatient,,,20.5,10.25,,15.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
MANUAL DIFF & SMEAR REVIEW,4119956,CDM,300,RC,85007,HCPCS,Outpatient,,,83.5,41.75,,4.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,4.33,66.8,
"PROTEIN ELECTROPHORESIS, URINE RANDOM",4119957,CDM,300,RC,84166,HCPCS,Outpatient,,,141,70.5,,22.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,112.8,80,,,percent of total billed charges,80% of total billed charges ,34.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,71.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,34.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.84,24,,,percent of total billed charges,24% of total billed charges ,43.99,31.2,,,percent of total billed charges,31.2% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,33.84,24,,,percent of total billed charges,24% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,22.43,112.8,
"VITAMIN B2, RIBOFLAVIN",4119977,CDM,301,RC,84252,HCPCS,Outpatient,,,129,64.5,,25.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,103.2,80,,,percent of total billed charges,80% of total billed charges ,31.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,65.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,96.75,75,,,percent of total billed charges,75% of total billed charges ,31.58,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,30.96,24,,,percent of total billed charges,24% of total billed charges ,40.25,31.2,,,percent of total billed charges,31.2% of total billed charges,103.2,80,,,percent of total billed charges,80% of total billed charges,30.96,24,,,percent of total billed charges,24% of total billed charges ,30.96,24,,,percent of total billed charges,24% of total billed charges ,25.45,103.2,
AERO ID & SUSCEPTIBILITY - QUEST,4119978,CDM,300,RC,87077,HCPCS,Outpatient,,,107,53.5,,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,80.25,75,,,percent of total billed charges,75% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,25.68,24,,,percent of total billed charges,24% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,85.6,80,,,percent of total billed charges,80% of total billed charges ,25.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,53.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,26.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.68,24,,,percent of total billed charges,24% of total billed charges ,33.38,31.2,,,percent of total billed charges,31.2% of total billed charges,85.6,80,,,percent of total billed charges,80% of total billed charges,25.68,24,,,percent of total billed charges,24% of total billed charges ,25.68,24,,,percent of total billed charges,24% of total billed charges ,10.16,85.6,
LEUK & LYMPH MARKERS - 88184,4119979,CDM,312,RC,88184,HCPCS,Outpatient,,,82.5,41.25,,46.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,46.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
LEUK & LYMPH MARKERS - 88185,4119980,CDM,312,RC,88185,HCPCS,Outpatient,,,46.5,23.25,,22.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
LEUK & LYMPH MARKERS - 88189,4119981,CDM,312,RC,88189,HCPCS,Outpatient,,,92.5,46.25,,98.26,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,74,80,,,percent of total billed charges,80% of total billed charges ,22.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,46.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,22.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,98.26,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.2,24,,,percent of total billed charges,24% of total billed charges ,28.86,31.2,,,percent of total billed charges,31.2% of total billed charges,74,80,,,percent of total billed charges,80% of total billed charges,22.2,24,,,percent of total billed charges,24% of total billed charges ,22.2,24,,,percent of total billed charges,24% of total billed charges ,22.2,98.26,
HCV RNA QUANT CHG ONLY,4119982,CDM,300,RC,87522,HCPCS,Outpatient,,,497.5,248.75,,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,373.13,75,,,percent of total billed charges,75% of total billed charges ,373.13,75,,,percent of total billed charges,75% of total billed charges ,119.4,24,,,percent of total billed charges,24% of total billed charges ,373.13,75,,,percent of total billed charges,75% of total billed charges ,373.13,75,,,percent of total billed charges,75% of total billed charges ,398,80,,,percent of total billed charges,80% of total billed charges ,120.59,24.24,,,percent of total billed charges,24.24% of total billed charges ,250.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,373.13,75,,,percent of total billed charges,75% of total billed charges ,121.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,119.4,24,,,percent of total billed charges,24% of total billed charges ,155.22,31.2,,,percent of total billed charges,31.2% of total billed charges,398,80,,,percent of total billed charges,80% of total billed charges,119.4,24,,,percent of total billed charges,24% of total billed charges ,119.4,24,,,percent of total billed charges,24% of total billed charges ,53.87,398,
"CANDIDA  ALBICANS IgG, IgA, IgM",4119983,CDM,300,RC,86628,HCPCS,Outpatient,,,535.5,267.75,,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,128.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,428.4,80,,,percent of total billed charges,80% of total billed charges ,129.81,24.24,,,percent of total billed charges,24.24% of total billed charges ,269.89,50.4,,,percent of total billed charges,50.4% of total billed charges ,401.63,75,,,percent of total billed charges,75% of total billed charges ,131.09,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,128.52,24,,,percent of total billed charges,24% of total billed charges ,167.08,31.2,,,percent of total billed charges,31.2% of total billed charges,428.4,80,,,percent of total billed charges,80% of total billed charges,128.52,24,,,percent of total billed charges,24% of total billed charges ,128.52,24,,,percent of total billed charges,24% of total billed charges ,15.1,428.4,
TOX/SEE URINE DRUG TEST,4119984,CDM,300,RC,80305,HCPCS,Outpatient,,,140,70,,11.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,105,75,,,percent of total billed charges,75% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,33.6,24,,,percent of total billed charges,24% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,112,80,,,percent of total billed charges,80% of total billed charges ,33.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,70.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,34.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.6,24,,,percent of total billed charges,24% of total billed charges ,43.68,31.2,,,percent of total billed charges,31.2% of total billed charges,112,80,,,percent of total billed charges,80% of total billed charges,33.6,24,,,percent of total billed charges,24% of total billed charges ,33.6,24,,,percent of total billed charges,24% of total billed charges ,11.47,112,
"CORTISOL, A.M.",4119985,CDM,301,RC,82533,HCPCS,Outpatient,,,144,72,,20.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,115.2,80,,,percent of total billed charges,80% of total billed charges ,34.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,35.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.56,24,,,percent of total billed charges,24% of total billed charges ,44.93,31.2,,,percent of total billed charges,31.2% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,20.5,115.2,
ANA MULTIPLEX w/ REFLEX TO 11 ABYS,4119986,CDM,300,RC,86038,HCPCS,Outpatient,,,170,85,,15.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,136,80,,,percent of total billed charges,80% of total billed charges ,41.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,85.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,41.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,24,,,percent of total billed charges,24% of total billed charges ,53.04,31.2,,,percent of total billed charges,31.2% of total billed charges,136,80,,,percent of total billed charges,80% of total billed charges,40.8,24,,,percent of total billed charges,24% of total billed charges ,40.8,24,,,percent of total billed charges,24% of total billed charges ,15.2,136,
PATH LEVEL VI SURG  - 88309-TC,4119999,CDM,310,RC,88309,HCPCS,Outpatient,,,262.5,131.25,,187.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,63,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,210,80,,,percent of total billed charges,80% of total billed charges ,63.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,132.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,196.88,75,,,percent of total billed charges,75% of total billed charges ,64.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,187.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63,24,,,percent of total billed charges,24% of total billed charges ,81.9,31.2,,,percent of total billed charges,31.2% of total billed charges,210,80,,,percent of total billed charges,80% of total billed charges,63,24,,,percent of total billed charges,24% of total billed charges ,63,24,,,percent of total billed charges,24% of total billed charges ,63,210,
PATHOLOGIST SMEAR REVIEW,4120000,CDM,300,RC,85007,HCPCS,Outpatient,,,51.5,25.75,,4.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,4.33,41.2,
EXECUTIVE PROFILE,4180050,CDM,521,RC,80050,HCPCS,Outpatient,,,127.5,63.75,,34.25,26.86,,,percent of total billed charges,26.86% of total billed charges,95.63,75,,,percent of total billed charges,75% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,95.63,75,,,percent of total billed charges,75% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,102,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,64.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,34.25,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,34.25,241.16,
ACETAMENOPHEN,4180307,CDM,301,RC,80143,HCPCS,Outpatient,,,,,,14.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.91,14.91,
URINE PREGNANCY TEST BY VISUAL COLOR,4181025,CDM,521,RC,81025,HCPCS,Outpatient,,,47.5,23.75,,7.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,7.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,7.96,241.16,
NO NOT USE(HEMO),4182270,CDM,521,RC,82270,HCPCS,Outpatient,,,25,12.5,,4.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.75,75,,,percent of total billed charges,75% of total billed charges ,18.75,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,18.75,75,,,percent of total billed charges,75% of total billed charges ,18.75,75,,,percent of total billed charges,75% of total billed charges ,20,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,12.6,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.75,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,4.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,4.04,241.16,
GLUCOMETER STRIP,4182948,CDM,301,RC,82948,HCPCS,Outpatient,,,21.5,10.75,,3.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,3.99,17.2,
GLUCOSE BLOOD BY GLUCOSE MONITORING DEVI,4182962,CDM,521,RC,82962,HCPCS,Outpatient,,,21.5,10.75,,2.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,2.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,2.94,241.16,
CULTURE BACTERIAL QUANTATIVE COLONY COUN,4187086,CDM,521,RC,87086,HCPCS,Outpatient,,,70,35,,10.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,35.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,10.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,10.15,241.16,
INFECTIOUS AGENT ANTIGEN DETECTION INFLU,4187804,CDM,521,RC,87804,HCPCS,Outpatient,,,63,31.5,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,50.4,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,15.08,241.16,
RBC MAGNESIUM,4190000,CDM,300,RC,83735,HCPCS,Outpatient,,,96,48,,8.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,8.42,76.8,
URINE PROTEIN/CREATININE RATIO,4190001,CDM,300,RC,82570,HCPCS,Outpatient,,,89.5,44.75,,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,67.13,75,,,percent of total billed charges,75% of total billed charges ,67.13,75,,,percent of total billed charges,75% of total billed charges ,21.48,24,,,percent of total billed charges,24% of total billed charges ,67.13,75,,,percent of total billed charges,75% of total billed charges ,67.13,75,,,percent of total billed charges,75% of total billed charges ,71.6,80,,,percent of total billed charges,80% of total billed charges ,21.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,45.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,67.13,75,,,percent of total billed charges,75% of total billed charges ,21.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.48,24,,,percent of total billed charges,24% of total billed charges ,27.92,31.2,,,percent of total billed charges,31.2% of total billed charges,71.6,80,,,percent of total billed charges,80% of total billed charges,21.48,24,,,percent of total billed charges,24% of total billed charges ,21.48,24,,,percent of total billed charges,24% of total billed charges ,6.51,71.6,
CBC,4190005,CDM,300,RC,85025,HCPCS,Outpatient,,,,,,9.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.77,9.77,
PT & aPTT,4190007,CDM,300,RC,85610,HCPCS,Outpatient,,,,,,4.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.94,4.94,
OCCULT BLOOD 2nd SPECIMEN,4190012,CDM,300,RC,82270,HCPCS,Outpatient,,,,,,4.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.04,4.04,
OCCULT BLOOD 3rd SPECIMEN,4190013,CDM,300,RC,82270,HCPCS,Outpatient,,,,,,4.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.04,4.04,
GTT 3 HOUR,4190016,CDM,300,RC,82951,HCPCS,Outpatient,,,,,,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.19,16.19,
FLU  A and B SCRN,4190029,CDM,300,RC,87400,HCPCS,Outpatient,,,202,101,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,161.6,80,,,percent of total billed charges,80% of total billed charges ,48.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,101.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,49.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,48.48,24,,,percent of total billed charges,24% of total billed charges ,63.02,31.2,,,percent of total billed charges,31.2% of total billed charges,161.6,80,,,percent of total billed charges,80% of total billed charges,48.48,24,,,percent of total billed charges,24% of total billed charges ,48.48,24,,,percent of total billed charges,24% of total billed charges ,15.08,161.6,
"SACCHAROMYCES CEREVISIAE ABS, IGG/IGA",4198004,CDM,302,RC,86671,HCPCS,Outpatient,,,,,,15.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.42,15.42,
DRUG SCREEN HANDLING FEE,4199000,CDM,521,RC,99000,HCPCS,Outpatient,,,22.5,11.25,,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,185.51,100,,,Case rate,pays based on per visit,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,18,80,,,percent of total billed charges,80% of total billed charges ,187.36,101,,,Case rate,pays based on per visit,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,189.22,102,,,Case rate,pays based on per visit,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,185.51,100,,,Case rate,pays based on per visit,241.16,130,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,185.51,100,,,Case rate,pays based on per visit,185.51,100,,,Case rate,pays based on per visit,6.04,241.16,
"KAPPA LAMBDA LT CHAINS, FREE, SERUM",4199001,CDM,300,RC,83521,HCPCS,Outpatient,,,108,54,,13.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,13.82,86.4,
"METANEPHRINES, URINE, 24HR",4199002,CDM,301,RC,83835,HCPCS,Outpatient,,,72,36,,21.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,57.6,
CMV PCR QUAL,4199003,CDM,306,RC,87496,HCPCS,Outpatient,,,306,153,,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,229.5,75,,,percent of total billed charges,75% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,73.44,24,,,percent of total billed charges,24% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,244.8,80,,,percent of total billed charges,80% of total billed charges ,74.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,154.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,74.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,73.44,24,,,percent of total billed charges,24% of total billed charges ,95.47,31.2,,,percent of total billed charges,31.2% of total billed charges,244.8,80,,,percent of total billed charges,80% of total billed charges,73.44,24,,,percent of total billed charges,24% of total billed charges ,73.44,24,,,percent of total billed charges,24% of total billed charges ,24.67,244.8,
PSA FREE AND TOTAL,4199008,CDM,999,RC,84153,HCPCS,Outpatient,,,133,66.5,,23.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,106.4,80,,,percent of total billed charges,80% of total billed charges ,32.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,67.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,32.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.92,24,,,percent of total billed charges,24% of total billed charges ,41.5,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,31.92,24,,,percent of total billed charges,24% of total billed charges ,31.92,24,,,percent of total billed charges,24% of total billed charges ,23.13,106.4,
EBV EARLY ANTIGEN IGG,4199012,CDM,300,RC,86663,HCPCS,Outpatient,,,219.5,109.75,,16.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,175.6,80,,,percent of total billed charges,80% of total billed charges ,53.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,110.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,164.63,75,,,percent of total billed charges,75% of total billed charges ,53.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,52.68,24,,,percent of total billed charges,24% of total billed charges ,68.48,31.2,,,percent of total billed charges,31.2% of total billed charges,175.6,80,,,percent of total billed charges,80% of total billed charges,52.68,24,,,percent of total billed charges,24% of total billed charges ,52.68,24,,,percent of total billed charges,24% of total billed charges ,16.5,175.6,
IGG SUBCLASS 2,4199025,CDM,300,RC,82787,HCPCS,Outpatient,,,,,,10.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.08,10.08,
FTA  TREPONEMAL AB,4199029,CDM,300,RC,86780,HCPCS,Outpatient,,,127.5,63.75,,34.25,26.86,,,percent of total billed charges,26.86% of total billed charges,95.63,75,,,percent of total billed charges,75% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,30.6,24,,,percent of total billed charges,24% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,102,80,,,percent of total billed charges,80% of total billed charges ,30.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,64.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,31.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,34.25,26.86,,,percent of total billed charges,26.86% of total billed charges,30.6,24,,,percent of total billed charges,24% of total billed charges ,39.78,31.2,,,percent of total billed charges,31.2% of total billed charges,102,80,,,percent of total billed charges,80% of total billed charges,30.6,24,,,percent of total billed charges,24% of total billed charges ,30.6,24,,,percent of total billed charges,24% of total billed charges ,30.6,102,
"EBV BY PCR, QUAL",4199030,CDM,300,RC,87798,HCPCS,Outpatient,,,309,154.5,,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,74.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,247.2,80,,,percent of total billed charges,80% of total billed charges ,74.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,155.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,231.75,75,,,percent of total billed charges,75% of total billed charges ,75.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,74.16,24,,,percent of total billed charges,24% of total billed charges ,96.41,31.2,,,percent of total billed charges,31.2% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,74.16,24,,,percent of total billed charges,24% of total billed charges ,74.16,24,,,percent of total billed charges,24% of total billed charges ,24.67,247.2,
BK VIRUS QUANT PCR URINE,4199031,CDM,300,RC,87799,HCPCS,Outpatient,,,889,444.5,,238.79,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,213.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,711.2,80,,,percent of total billed charges,80% of total billed charges ,215.49,24.24,,,percent of total billed charges,24.24% of total billed charges ,448.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,666.75,75,,,percent of total billed charges,75% of total billed charges ,217.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,238.79,26.86,,,percent of total billed charges,26.86% of total billed charges,213.36,24,,,percent of total billed charges,24% of total billed charges ,277.37,31.2,,,percent of total billed charges,31.2% of total billed charges,711.2,80,,,percent of total billed charges,80% of total billed charges,213.36,24,,,percent of total billed charges,24% of total billed charges ,213.36,24,,,percent of total billed charges,24% of total billed charges ,213.36,711.2,
ANDROSTENEDIONE,4199033,CDM,300,RC,82157,HCPCS,Outpatient,,,344,172,,36.81,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,82.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,275.2,80,,,percent of total billed charges,80% of total billed charges ,83.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,173.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,258,75,,,percent of total billed charges,75% of total billed charges ,84.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.81,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,82.56,24,,,percent of total billed charges,24% of total billed charges ,107.33,31.2,,,percent of total billed charges,31.2% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,82.56,24,,,percent of total billed charges,24% of total billed charges ,82.56,24,,,percent of total billed charges,24% of total billed charges ,36.81,275.2,
GLIADIN AB IGA,4199034,CDM,300,RC,86258,HCPCS,Outpatient,,,255.5,127.75,,9.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,204.4,80,,,percent of total billed charges,80% of total billed charges ,61.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,128.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,191.63,75,,,percent of total billed charges,75% of total billed charges ,62.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.32,24,,,percent of total billed charges,24% of total billed charges ,79.72,31.2,,,percent of total billed charges,31.2% of total billed charges,204.4,80,,,percent of total billed charges,80% of total billed charges,61.32,24,,,percent of total billed charges,24% of total billed charges ,61.32,24,,,percent of total billed charges,24% of total billed charges ,9.22,204.4,
QUANTIFERON TB GOLD,4199036,CDM,300,RC,86480,HCPCS,Outpatient,,,284.5,142.25,,77.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,227.6,80,,,percent of total billed charges,80% of total billed charges ,68.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,143.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,213.38,75,,,percent of total billed charges,75% of total billed charges ,69.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,77.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.28,24,,,percent of total billed charges,24% of total billed charges ,88.76,31.2,,,percent of total billed charges,31.2% of total billed charges,227.6,80,,,percent of total billed charges,80% of total billed charges,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,24,,,percent of total billed charges,24% of total billed charges ,68.28,227.6,
PH BODY FLUID,4199037,CDM,300,RC,83986,HCPCS,Outpatient,,,227.5,113.75,,4.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,182,80,,,percent of total billed charges,80% of total billed charges ,55.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,114.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,55.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.6,24,,,percent of total billed charges,24% of total billed charges ,70.98,31.2,,,percent of total billed charges,31.2% of total billed charges,182,80,,,percent of total billed charges,80% of total billed charges,54.6,24,,,percent of total billed charges,24% of total billed charges ,54.6,24,,,percent of total billed charges,24% of total billed charges ,4.5,182,
"TOTAL PROTEIN, SYNOVIAL FLUID",4199038,CDM,300,RC,84157,HCPCS,Outpatient,,,96,48,,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,4.61,76.8,
CORTISOL FREE (SERUM),4199039,CDM,301,RC,82530,HCPCS,Outpatient,,,166,83,,21.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,21.02,132.8,
COLOVANTAGE,4199040,CDM,300,RC,81327,HCPCS,Outpatient,,,766.5,383.25,,66.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,183.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,613.2,80,,,percent of total billed charges,80% of total billed charges ,185.8,24.24,,,percent of total billed charges,24.24% of total billed charges ,386.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,574.88,75,,,percent of total billed charges,75% of total billed charges ,187.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,66.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,183.96,24,,,percent of total billed charges,24% of total billed charges ,239.15,31.2,,,percent of total billed charges,31.2% of total billed charges,613.2,80,,,percent of total billed charges,80% of total billed charges,183.96,24,,,percent of total billed charges,24% of total billed charges ,183.96,24,,,percent of total billed charges,24% of total billed charges ,66.94,613.2,
CADMIUM,4199041,CDM,301,RC,82300,HCPCS,Outpatient,,,188.5,94.25,,29.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.8,80,,,percent of total billed charges,80% of total billed charges ,45.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,95,50.4,,,percent of total billed charges,50.4% of total billed charges ,141.38,75,,,percent of total billed charges,75% of total billed charges ,46.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.24,24,,,percent of total billed charges,24% of total billed charges ,58.81,31.2,,,percent of total billed charges,31.2% of total billed charges,150.8,80,,,percent of total billed charges,80% of total billed charges,45.24,24,,,percent of total billed charges,24% of total billed charges ,45.24,24,,,percent of total billed charges,24% of total billed charges ,29.1,150.8,
AMITRIPTYLINE,4199042,CDM,301,RC,80335,HCPCS,Outpatient,,,166,83,,22.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,22.51,132.8,
SACCHAROPOLYSPORA RECTIVIRGULA,4199043,CDM,300,RC,86609,HCPCS,Outpatient,,,110,55,,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,16.2,88,
SACCHAROMONOSPORA VIRIDIS,4199044,CDM,300,RC,86609,HCPCS,Outpatient,,,110,55,,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,16.2,88,
THERMOACTINOMYCES CANDIDUS,4199045,CDM,300,RC,86609,HCPCS,Outpatient,,,110,55,,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,16.2,88,
THERMOACTINOMYCES SACCHARI,4199046,CDM,300,RC,86609,HCPCS,Outpatient,,,110,55,,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,16.2,88,
THERMOACTINOMYCES VULGARIS,4199047,CDM,300,RC,86609,HCPCS,Outpatient,,,110,55,,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,16.2,88,
AUREOBASIDIUM PULLULANS IGG,4199048,CDM,300,RC,86001,HCPCS,Outpatient,,,110,55,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,6.57,88,
PHOMA SPP IGG,4199049,CDM,300,RC,86001,HCPCS,Outpatient,,,110,55,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,6.57,88,
TRICHODERMA VIRIDE IGG,4199050,CDM,300,RC,86001,HCPCS,Outpatient,,,110,55,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,6.57,88,
MIXED FEATHERS IGG,4199051,CDM,300,RC,86001,HCPCS,Outpatient,,,110,55,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,6.57,88,
PIGEON DROPPINGS IGG,4199052,CDM,300,RC,86001,HCPCS,Outpatient,,,110,55,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,6.57,88,
COLONY COUNT URINE,4199054,CDM,300,RC,87086,HCPCS,Outpatient,,,85.5,42.75,,10.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.4,80,,,percent of total billed charges,80% of total billed charges ,20.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,43.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,20.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.52,24,,,percent of total billed charges,24% of total billed charges ,26.68,31.2,,,percent of total billed charges,31.2% of total billed charges,68.4,80,,,percent of total billed charges,80% of total billed charges,20.52,24,,,percent of total billed charges,24% of total billed charges ,20.52,24,,,percent of total billed charges,24% of total billed charges ,10.15,68.4,
BACTERIAL IDENTIFICATION CHARGE ONLY,4199055,CDM,300,RC,87077,HCPCS,Outpatient,,,107,53.5,,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,80.25,75,,,percent of total billed charges,75% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,25.68,24,,,percent of total billed charges,24% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,85.6,80,,,percent of total billed charges,80% of total billed charges ,25.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,53.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,26.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.68,24,,,percent of total billed charges,24% of total billed charges ,33.38,31.2,,,percent of total billed charges,31.2% of total billed charges,85.6,80,,,percent of total billed charges,80% of total billed charges,25.68,24,,,percent of total billed charges,24% of total billed charges ,25.68,24,,,percent of total billed charges,24% of total billed charges ,10.16,85.6,
.CRYPTOSPORIDIUM AG EIA,4199056,CDM,300,RC,87328,HCPCS,Outpatient,,,101,50.5,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,15.08,80.8,
ENTAMOEBA  DISPAR,4199057,CDM,300,RC,87336,HCPCS,Outpatient,,,67,33.5,,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,15.08,53.6,
INTRINSIC FACTOR BLOCK AB,4199064,CDM,300,RC,86340,HCPCS,Outpatient,,,166,83,,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,18.95,132.8,
COLLAGEN TYPE I C-TELE,4199065,CDM,300,RC,82523,HCPCS,Outpatient,,,210,105,,23.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,50.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,168,80,,,percent of total billed charges,80% of total billed charges ,50.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,105.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,157.5,75,,,percent of total billed charges,75% of total billed charges ,51.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,50.4,24,,,percent of total billed charges,24% of total billed charges ,65.52,31.2,,,percent of total billed charges,31.2% of total billed charges,168,80,,,percent of total billed charges,80% of total billed charges,50.4,24,,,percent of total billed charges,24% of total billed charges ,50.4,24,,,percent of total billed charges,24% of total billed charges ,23.5,168,
RETINOL BINDING PROTEIN,4199066,CDM,300,RC,83883,HCPCS,Outpatient,,,108,54,,17.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,17.1,86.4,
MOUSE URINE PROTEIN IGE,4199067,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
CREATINE SERUM,4199068,CDM,301,RC,82540,HCPCS,Outpatient,,,213,106.5,,5.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.4,80,,,percent of total billed charges,80% of total billed charges ,51.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,107.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,159.75,75,,,percent of total billed charges,75% of total billed charges ,52.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.12,24,,,percent of total billed charges,24% of total billed charges ,66.46,31.2,,,percent of total billed charges,31.2% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.12,24,,,percent of total billed charges,24% of total billed charges ,51.12,24,,,percent of total billed charges,24% of total billed charges ,5.83,170.4,
ESLICARBAZEPINE,4199069,CDM,301,RC,80299,HCPCS,Outpatient,,,356.5,178.25,,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,15.14,285.2,
STRAWBERRY RAST IGE,4199070,CDM,300,RC,86003,HCPCS,Outpatient,,,59.5,29.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,6.57,47.6,
RASPBERRY RAST IGE,4199071,CDM,300,RC,86003,HCPCS,Outpatient,,,59.5,29.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,6.57,47.6,
PEANUT RAST IGE,4199072,CDM,300,RC,86003,HCPCS,Outpatient,,,59.5,29.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,6.57,47.6,
GRAPE RAST IGE,4199073,CDM,300,RC,86003,HCPCS,Outpatient,,,59.5,29.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,6.57,47.6,
GLYCOMARK,4199074,CDM,300,RC,84378,HCPCS,Outpatient,,,96,48,,14.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,14.49,76.8,
11-DEHYDROTHROMBOXANE B2,4199075,CDM,300,RC,84431,HCPCS,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
SCALLOP IGE,4199076,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
WHEAT IGE AB RAST,4199077,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
CORN IGE,4199078,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
SESAME SEED IGE,4199079,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
HLA CELIAC DISEASE,4199080,CDM,300,RC,81382,HCPCS,Outpatient,,,297.5,148.75,,164,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,238,80,,,percent of total billed charges,80% of total billed charges ,72.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,149.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,72.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,164,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,24,,,percent of total billed charges,24% of total billed charges ,92.82,31.2,,,percent of total billed charges,31.2% of total billed charges,238,80,,,percent of total billed charges,80% of total billed charges,71.4,24,,,percent of total billed charges,24% of total billed charges ,71.4,24,,,percent of total billed charges,24% of total billed charges ,71.4,238,
SOYBEAN IGE,4199081,CDM,300,RC,86003,HCPCS,Outpatient,,,59.5,29.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,6.57,47.6,
WALNUT IGE,4199082,CDM,300,RC,86003,HCPCS,Outpatient,,,59.5,29.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,6.57,47.6,
CLAM IGE AB,4199083,CDM,300,RC,86003,HCPCS,Outpatient,,,58.5,29.25,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,6.57,46.8,
COW MILK IGE,4199084,CDM,300,RC,86003,HCPCS,Outpatient,,,59.5,29.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,6.57,47.6,
EGG WHITE IGE,4199085,CDM,300,RC,86003,HCPCS,Outpatient,,,59.5,29.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,6.57,47.6,
FOOD ALLERGY PANEL,4199086,CDM,300,RC,86003,HCPCS,Outpatient,,,438,219,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,105.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,350.4,80,,,percent of total billed charges,80% of total billed charges ,106.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,220.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,328.5,75,,,percent of total billed charges,75% of total billed charges ,107.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,105.12,24,,,percent of total billed charges,24% of total billed charges ,136.66,31.2,,,percent of total billed charges,31.2% of total billed charges,350.4,80,,,percent of total billed charges,80% of total billed charges,105.12,24,,,percent of total billed charges,24% of total billed charges ,105.12,24,,,percent of total billed charges,24% of total billed charges ,6.57,350.4,
TRYPSIN SERUM,4199087,CDM,300,RC,83519,HCPCS,Outpatient,,,357.5,178.75,,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,286,80,,,percent of total billed charges,80% of total billed charges ,86.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,180.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,268.13,75,,,percent of total billed charges,75% of total billed charges ,87.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.8,24,,,percent of total billed charges,24% of total billed charges ,111.54,31.2,,,percent of total billed charges,31.2% of total billed charges,286,80,,,percent of total billed charges,80% of total billed charges,85.8,24,,,percent of total billed charges,24% of total billed charges ,85.8,24,,,percent of total billed charges,24% of total billed charges ,16.99,286,
ALPHA2MACROGLOBULIN,4199088,CDM,300,RC,83883,HCPCS,Outpatient,,,108,54,,17.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,17.1,86.4,
PHENYTOIN FREE,4199090,CDM,301,RC,80186,HCPCS,Outpatient,,,166,83,,17.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,17.31,132.8,
CYSTIC FIBROSIS SCREEN,4199091,CDM,300,RC,81220,HCPCS,Outpatient,,,69,34.5,,960,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.2,80,,,percent of total billed charges,80% of total billed charges ,16.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,960,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.56,24,,,percent of total billed charges,24% of total billed charges ,21.53,31.2,,,percent of total billed charges,31.2% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,960,
PROCALCITONIN,4199092,CDM,300,RC,84145,HCPCS,Outpatient,,,631.5,315.75,,24.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,151.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,505.2,80,,,percent of total billed charges,80% of total billed charges ,153.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,318.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,473.63,75,,,percent of total billed charges,75% of total billed charges ,154.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,151.56,24,,,percent of total billed charges,24% of total billed charges ,197.03,31.2,,,percent of total billed charges,31.2% of total billed charges,505.2,80,,,percent of total billed charges,80% of total billed charges,151.56,24,,,percent of total billed charges,24% of total billed charges ,151.56,24,,,percent of total billed charges,24% of total billed charges ,24.06,505.2,
C1 INHIBITOR FUNCTIONAL,4199093,CDM,300,RC,86161,HCPCS,Outpatient,,,,,,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.1,15.1,
"LYME DISEASE AB (IGG, IGM) IMMUNOBLOT",4199094,CDM,300,RC,86618,HCPCS,Outpatient,,,274,137,,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,65.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,219.2,80,,,percent of total billed charges,80% of total billed charges ,66.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,138.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,205.5,75,,,percent of total billed charges,75% of total billed charges ,67.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,65.76,24,,,percent of total billed charges,24% of total billed charges ,85.49,31.2,,,percent of total billed charges,31.2% of total billed charges,219.2,80,,,percent of total billed charges,80% of total billed charges,65.76,24,,,percent of total billed charges,24% of total billed charges ,65.76,24,,,percent of total billed charges,24% of total billed charges ,21.42,219.2,
PINEAPPLE RAST IGE,4199095,CDM,300,RC,86003,HCPCS,Outpatient,,,59.5,29.75,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,6.57,47.6,
HEPATIC FUNCTION (SCP),4199096,CDM,301,RC,80076,HCPCS,Outpatient,,,17.5,8.75,,10.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14,80,,,percent of total billed charges,80% of total billed charges ,4.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,4.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.2,24,,,percent of total billed charges,24% of total billed charges ,5.46,31.2,,,percent of total billed charges,31.2% of total billed charges,14,80,,,percent of total billed charges,80% of total billed charges,4.2,24,,,percent of total billed charges,24% of total billed charges ,4.2,24,,,percent of total billed charges,24% of total billed charges ,4.2,14,
CBC W/DIFF & PLT (SCP),4199097,CDM,300,RC,85025,HCPCS,Outpatient,,,16.5,8.25,,9.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
AMYLASE (SCP),4199098,CDM,301,RC,82150,HCPCS,Outpatient,,,14.5,7.25,,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
BILIRUBIN TOTAL (SCP),4199099,CDM,301,RC,82247,HCPCS,Outpatient,,,11.5,5.75,,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,9.2,80,,,percent of total billed charges,80% of total billed charges ,2.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,2.76,24,,,percent of total billed charges,24% of total billed charges ,3.59,31.2,,,percent of total billed charges,31.2% of total billed charges,9.2,80,,,percent of total billed charges,80% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,9.2,
GGTP (SCP),4199100,CDM,300,RC,82977,HCPCS,Outpatient,,,15.5,7.75,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
HDL CHOLESTEROL (SCP),4199101,CDM,300,RC,83718,HCPCS,Outpatient,,,12.5,6.25,,10.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10.3,
LIPID PANEL (SCP),4199102,CDM,300,RC,80061,HCPCS,Outpatient,,,50.5,25.25,,16.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,37.88,75,,,percent of total billed charges,75% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,12.12,24,,,percent of total billed charges,24% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,40.4,80,,,percent of total billed charges,80% of total billed charges ,12.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,12.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.12,24,,,percent of total billed charges,24% of total billed charges ,15.76,31.2,,,percent of total billed charges,31.2% of total billed charges,40.4,80,,,percent of total billed charges,80% of total billed charges,12.12,24,,,percent of total billed charges,24% of total billed charges ,12.12,24,,,percent of total billed charges,24% of total billed charges ,12.12,40.4,
TRIGLYCERIDES (SCP),4199103,CDM,300,RC,84478,HCPCS,Outpatient,,,12.5,6.25,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
CHOLESTEROL (SCP),4199104,CDM,301,RC,82465,HCPCS,Outpatient,,,12.5,6.25,,5.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
LIPASE (SCP),4199105,CDM,300,RC,83690,HCPCS,Outpatient,,,15.5,7.75,,8.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
RPR (SCP),4199106,CDM,300,RC,86592,HCPCS,Outpatient,,,13.5,6.75,,4.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.8,80,,,percent of total billed charges,80% of total billed charges ,3.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.24,24,,,percent of total billed charges,24% of total billed charges ,4.21,31.2,,,percent of total billed charges,31.2% of total billed charges,10.8,80,,,percent of total billed charges,80% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,10.8,
T4 FREE (SCP),4199107,CDM,300,RC,84439,HCPCS,Outpatient,,,28,14,,11.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.4,80,,,percent of total billed charges,80% of total billed charges ,6.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.72,24,,,percent of total billed charges,24% of total billed charges ,8.74,31.2,,,percent of total billed charges,31.2% of total billed charges,22.4,80,,,percent of total billed charges,80% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,22.4,
T3 UPTAKE (SCP),4199108,CDM,300,RC,84479,HCPCS,Outpatient,,,28,14,,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.4,80,,,percent of total billed charges,80% of total billed charges ,6.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.72,24,,,percent of total billed charges,24% of total billed charges ,8.74,31.2,,,percent of total billed charges,31.2% of total billed charges,22.4,80,,,percent of total billed charges,80% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,22.4,
TSH (SCP),4199109,CDM,300,RC,84443,HCPCS,Outpatient,,,37,18.5,,21.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
AMMONIA (SCP),4199110,CDM,301,RC,82140,HCPCS,Outpatient,,,21.5,10.75,,12.44,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.44,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
VITAMIN B12 (SCP),4199111,CDM,301,RC,82607,HCPCS,Outpatient,,,33,16.5,,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
IRON (SCP),4199112,CDM,300,RC,83540,HCPCS,Outpatient,,,14.5,7.25,,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
PROTIME/INR (SCP),4199113,CDM,300,RC,85610,HCPCS,Outpatient,,,11.5,5.75,,4.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,9.2,80,,,percent of total billed charges,80% of total billed charges ,2.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,2.76,24,,,percent of total billed charges,24% of total billed charges ,3.59,31.2,,,percent of total billed charges,31.2% of total billed charges,9.2,80,,,percent of total billed charges,80% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,9.2,
HEP C RNA PCR (SCP),4199114,CDM,300,RC,87522,HCPCS,Outpatient,,,63,31.5,,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,53.87,
....C METABOLIC  PANEL (SCP),4199115,CDM,301,RC,80053,HCPCS,Outpatient,,,22.5,11.25,,13.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,18,
ELECTROLYTES (SCP),4199116,CDM,301,RC,80051,HCPCS,Outpatient,,,8,4,,8.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6,75,,,percent of total billed charges,75% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,6.4,80,,,percent of total billed charges,80% of total billed charges ,1.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,1.92,24,,,percent of total billed charges,24% of total billed charges ,2.5,31.2,,,percent of total billed charges,31.2% of total billed charges,6.4,80,,,percent of total billed charges,80% of total billed charges,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,8.82,
T4 TOTAL (SCP),4199117,CDM,300,RC,84436,HCPCS,Outpatient,,,28,14,,8.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.4,80,,,percent of total billed charges,80% of total billed charges ,6.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.72,24,,,percent of total billed charges,24% of total billed charges ,8.74,31.2,,,percent of total billed charges,31.2% of total billed charges,22.4,80,,,percent of total billed charges,80% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,22.4,
DIRECT BILIRUBIN (SCP),4199118,CDM,301,RC,82248,HCPCS,Outpatient,,,11.5,5.75,,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,9.2,80,,,percent of total billed charges,80% of total billed charges ,2.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,2.76,24,,,percent of total billed charges,24% of total billed charges ,3.59,31.2,,,percent of total billed charges,31.2% of total billed charges,9.2,80,,,percent of total billed charges,80% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,9.2,
CARDIO IQ ADVANCED LIPID PANEL,4199119,CDM,300,RC,83704,HCPCS,Outpatient,,,474,237,,39.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,113.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,379.2,80,,,percent of total billed charges,80% of total billed charges ,114.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,238.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,116.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,39.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,113.76,24,,,percent of total billed charges,24% of total billed charges ,147.89,31.2,,,percent of total billed charges,31.2% of total billed charges,379.2,80,,,percent of total billed charges,80% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,39.67,379.2,
"LYME DISEASE AB W/REFLEX BLOT(IGG,IGM)",4199120,CDM,300,RC,86618,HCPCS,Outpatient,,,274,137,,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,65.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,219.2,80,,,percent of total billed charges,80% of total billed charges ,66.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,138.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,205.5,75,,,percent of total billed charges,75% of total billed charges ,67.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,65.76,24,,,percent of total billed charges,24% of total billed charges ,85.49,31.2,,,percent of total billed charges,31.2% of total billed charges,219.2,80,,,percent of total billed charges,80% of total billed charges,65.76,24,,,percent of total billed charges,24% of total billed charges ,65.76,24,,,percent of total billed charges,24% of total billed charges ,21.42,219.2,
CYTOLOGY NON GYN SMEAR NIPPLE DISCHARGE,4199122,CDM,311,RC,88161,HCPCS,Outpatient,,,58.5,29.25,,34.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,34.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,46.8,
CPK (SCP),4199123,CDM,301,RC,82550,HCPCS,Outpatient,,,14.5,7.25,,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
CARDIAC PANEL (CKMB/TROP)  SCP,4199124,CDM,300,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
"HCV RNA GENOTYPE, LIPA",4199126,CDM,300,RC,87902,HCPCS,Outpatient,,,1011.5,505.75,,109.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,758.63,75,,,percent of total billed charges,75% of total billed charges ,758.63,75,,,percent of total billed charges,75% of total billed charges ,242.76,24,,,percent of total billed charges,24% of total billed charges ,758.63,75,,,percent of total billed charges,75% of total billed charges ,758.63,75,,,percent of total billed charges,75% of total billed charges ,809.2,80,,,percent of total billed charges,80% of total billed charges ,245.19,24.24,,,percent of total billed charges,24.24% of total billed charges ,509.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,758.63,75,,,percent of total billed charges,75% of total billed charges ,247.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,109.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,242.76,24,,,percent of total billed charges,24% of total billed charges ,315.59,31.2,,,percent of total billed charges,31.2% of total billed charges,809.2,80,,,percent of total billed charges,80% of total billed charges,242.76,24,,,percent of total billed charges,24% of total billed charges ,242.76,24,,,percent of total billed charges,24% of total billed charges ,109.67,809.2,
TOXOPLASMA IGG & IGM W/REFLEX,4199127,CDM,300,RC,86777,HCPCS,Outpatient,,,166,83,,14.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,14.63,132.8,
CRYPTOCOCCAL ANTIGEN WREFLEX TITER,4199128,CDM,300,RC,86403,HCPCS,Outpatient,,,166,83,,10,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,10,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,10,132.8,
D-DIMER (SCP),4199129,CDM,300,RC,85379,HCPCS,Outpatient,,,22.5,11.25,,12.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,18,
"KAPPA LAMBDA LIGHT CHAINS FREE, URINE",4199130,CDM,300,RC,83521,HCPCS,Outpatient,,,108,54,,13.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,86.4,80,,,percent of total billed charges,80% of total billed charges ,26.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,26.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.92,24,,,percent of total billed charges,24% of total billed charges ,33.7,31.2,,,percent of total billed charges,31.2% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,25.92,24,,,percent of total billed charges,24% of total billed charges ,25.92,24,,,percent of total billed charges,24% of total billed charges ,13.82,86.4,
DEXAMETHASONE,4199131,CDM,301,RC,80299,HCPCS,Outpatient,,,297.5,148.75,,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,238,80,,,percent of total billed charges,80% of total billed charges ,72.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,149.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,72.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,24,,,percent of total billed charges,24% of total billed charges ,92.82,31.2,,,percent of total billed charges,31.2% of total billed charges,238,80,,,percent of total billed charges,80% of total billed charges,71.4,24,,,percent of total billed charges,24% of total billed charges ,71.4,24,,,percent of total billed charges,24% of total billed charges ,15.14,238,
CORTISOL FREE 24 HR URINE,4199132,CDM,301,RC,82530,HCPCS,Outpatient,,,166,83,,21.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,21.02,132.8,
ANTI-MULLERIAN HORMONE,4199133,CDM,301,RC,82397,HCPCS,Outpatient,,,173,86.5,,17.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,41.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,138.4,80,,,percent of total billed charges,80% of total billed charges ,41.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,87.19,50.4,,,percent of total billed charges,50.4% of total billed charges ,129.75,75,,,percent of total billed charges,75% of total billed charges ,42.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,41.52,24,,,percent of total billed charges,24% of total billed charges ,53.98,31.2,,,percent of total billed charges,31.2% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,41.52,24,,,percent of total billed charges,24% of total billed charges ,41.52,24,,,percent of total billed charges,24% of total billed charges ,17.77,138.4,
VITAMIN B7 (BIOTIN),4199134,CDM,301,RC,84591,HCPCS,Outpatient,,,178,89,,14.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,14.58,142.4,
VITAMIN B3,4199135,CDM,301,RC,84591,HCPCS,Outpatient,,,178,89,,14.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,14.58,142.4,
VITAMIN B5 (PANTOTHENIC ACID),4199136,CDM,301,RC,84591,HCPCS,Outpatient,,,178,89,,14.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,14.58,142.4,
"MICROALBUMIN, URINE QUANT",4199137,CDM,301,RC,82043,HCPCS,Outpatient,,,114.5,57.25,,7.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,7.28,91.6,
DRUG TEST CONFIRMATION 1-7 CLASSES,4199138,CDM,300,RC,G0480,HCPCS,Outpatient,,,375,187.5,,94.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,281.25,75,,,percent of total billed charges,75% of total billed charges ,281.25,75,,,percent of total billed charges,75% of total billed charges ,90,24,,,percent of total billed charges,24% of total billed charges ,281.25,75,,,percent of total billed charges,75% of total billed charges ,281.25,75,,,percent of total billed charges,75% of total billed charges ,300,80,,,percent of total billed charges,80% of total billed charges ,90.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,189,50.4,,,percent of total billed charges,50.4% of total billed charges ,281.25,75,,,percent of total billed charges,75% of total billed charges ,91.8,24.48,,,percent of total billed charges,24.48% of total billed charges ,94.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,90,24,,,percent of total billed charges,24% of total billed charges ,117,31.2,,,percent of total billed charges,31.2% of total billed charges,300,80,,,percent of total billed charges,80% of total billed charges,90,24,,,percent of total billed charges,24% of total billed charges ,90,24,,,percent of total billed charges,24% of total billed charges ,90,300,
DRUG TEST CONFIRMATION 8-14 CLASSES,4199139,CDM,300,RC,G0481,HCPCS,Outpatient,,,512,256,,128.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,384,75,,,percent of total billed charges,75% of total billed charges ,384,75,,,percent of total billed charges,75% of total billed charges ,122.88,24,,,percent of total billed charges,24% of total billed charges ,384,75,,,percent of total billed charges,75% of total billed charges ,384,75,,,percent of total billed charges,75% of total billed charges ,409.6,80,,,percent of total billed charges,80% of total billed charges ,124.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,258.05,50.4,,,percent of total billed charges,50.4% of total billed charges ,384,75,,,percent of total billed charges,75% of total billed charges ,125.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,128.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,122.88,24,,,percent of total billed charges,24% of total billed charges ,159.74,31.2,,,percent of total billed charges,31.2% of total billed charges,409.6,80,,,percent of total billed charges,80% of total billed charges,122.88,24,,,percent of total billed charges,24% of total billed charges ,122.88,24,,,percent of total billed charges,24% of total billed charges ,122.88,409.6,
DRUG TEST CONFIRMATION 15-21 CLASSES,4199140,CDM,300,RC,G0482,HCPCS,Outpatient,,,650,325,,163.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,487.5,75,,,percent of total billed charges,75% of total billed charges ,487.5,75,,,percent of total billed charges,75% of total billed charges ,156,24,,,percent of total billed charges,24% of total billed charges ,487.5,75,,,percent of total billed charges,75% of total billed charges ,487.5,75,,,percent of total billed charges,75% of total billed charges ,520,80,,,percent of total billed charges,80% of total billed charges ,157.56,24.24,,,percent of total billed charges,24.24% of total billed charges ,327.6,50.4,,,percent of total billed charges,50.4% of total billed charges ,487.5,75,,,percent of total billed charges,75% of total billed charges ,159.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,163.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,156,24,,,percent of total billed charges,24% of total billed charges ,202.8,31.2,,,percent of total billed charges,31.2% of total billed charges,520,80,,,percent of total billed charges,80% of total billed charges,156,24,,,percent of total billed charges,24% of total billed charges ,156,24,,,percent of total billed charges,24% of total billed charges ,156,520,
DRUG TEST CONFIRMATION 22+ CLASSES,4199141,CDM,300,RC,G0483,HCPCS,Outpatient,,,807.5,403.75,,203.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,605.63,75,,,percent of total billed charges,75% of total billed charges ,605.63,75,,,percent of total billed charges,75% of total billed charges ,193.8,24,,,percent of total billed charges,24% of total billed charges ,605.63,75,,,percent of total billed charges,75% of total billed charges ,605.63,75,,,percent of total billed charges,75% of total billed charges ,646,80,,,percent of total billed charges,80% of total billed charges ,195.74,24.24,,,percent of total billed charges,24.24% of total billed charges ,406.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,605.63,75,,,percent of total billed charges,75% of total billed charges ,197.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,203.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,193.8,24,,,percent of total billed charges,24% of total billed charges ,251.94,31.2,,,percent of total billed charges,31.2% of total billed charges,646,80,,,percent of total billed charges,80% of total billed charges,193.8,24,,,percent of total billed charges,24% of total billed charges ,193.8,24,,,percent of total billed charges,24% of total billed charges ,193.8,646,
URINE DRUG SCREEN,4199142,CDM,300,RC,80307,HCPCS,Outpatient,,,229.35,114.68,,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,183.48,80,,,percent of total billed charges,80% of total billed charges ,55.59,24.24,,,percent of total billed charges,24.24% of total billed charges ,115.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,172.01,75,,,percent of total billed charges,75% of total billed charges ,56.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,55.04,24,,,percent of total billed charges,24% of total billed charges ,71.56,31.2,,,percent of total billed charges,31.2% of total billed charges,183.48,80,,,percent of total billed charges,80% of total billed charges,55.04,24,,,percent of total billed charges,24% of total billed charges ,55.04,24,,,percent of total billed charges,24% of total billed charges ,55.04,183.48,
CMV Quantification DNA/PCR,4199148,CDM,300,RC,87497,HCPCS,Outpatient,,,306,153,,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,229.5,75,,,percent of total billed charges,75% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,73.44,24,,,percent of total billed charges,24% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,244.8,80,,,percent of total billed charges,80% of total billed charges ,74.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,154.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,74.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,73.44,24,,,percent of total billed charges,24% of total billed charges ,95.47,31.2,,,percent of total billed charges,31.2% of total billed charges,244.8,80,,,percent of total billed charges,80% of total billed charges,73.44,24,,,percent of total billed charges,24% of total billed charges ,73.44,24,,,percent of total billed charges,24% of total billed charges ,53.87,244.8,
ZIKA VIRUS ANTIBODY IGM,4199149,CDM,302,RC,86794,HCPCS,Outpatient,,,318.5,159.25,,16.64,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,238.88,75,,,percent of total billed charges,75% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,76.44,24,,,percent of total billed charges,24% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,254.8,80,,,percent of total billed charges,80% of total billed charges ,77.2,24.24,,,percent of total billed charges,24.24% of total billed charges ,160.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,77.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.64,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,76.44,24,,,percent of total billed charges,24% of total billed charges ,99.37,31.2,,,percent of total billed charges,31.2% of total billed charges,254.8,80,,,percent of total billed charges,80% of total billed charges,76.44,24,,,percent of total billed charges,24% of total billed charges ,76.44,24,,,percent of total billed charges,24% of total billed charges ,16.64,254.8,
"PANCREATIC ELASTASE, STOOL",4199150,CDM,300,RC,82656,HCPCS,Outpatient,,,45.5,22.75,,12.22,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.22,26.86,,,percent of total billed charges,26.86% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,36.4,80,,,percent of total billed charges,80% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,36.4,
BULLOUS PEMPHIGOID ANTIBODY 180,4199151,CDM,300,RC,83520,HCPCS,Outpatient,,,54.5,27.25,,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,43.6,80,,,percent of total billed charges,80% of total billed charges ,13.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,27.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,13.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.08,24,,,percent of total billed charges,24% of total billed charges ,17,31.2,,,percent of total billed charges,31.2% of total billed charges,43.6,80,,,percent of total billed charges,80% of total billed charges,13.08,24,,,percent of total billed charges,24% of total billed charges ,13.08,24,,,percent of total billed charges,24% of total billed charges ,13.08,43.6,
"NICOTINE & COTININE, Serum/Plasma",4199152,CDM,999,RC,,,Outpatient,,,362.5,181.25,,97.37,26.86,,,percent of total billed charges,26.86% of total billed charges,271.88,75,,,percent of total billed charges,75% of total billed charges ,271.88,75,,,percent of total billed charges,75% of total billed charges ,87,24,,,percent of total billed charges,24% of total billed charges ,271.88,75,,,percent of total billed charges,75% of total billed charges ,271.88,75,,,percent of total billed charges,75% of total billed charges ,290,80,,,percent of total billed charges,80% of total billed charges ,87.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,182.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,271.88,75,,,percent of total billed charges,75% of total billed charges ,88.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,97.37,26.86,,,percent of total billed charges,26.86% of total billed charges,87,24,,,percent of total billed charges,24% of total billed charges ,113.1,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,87,24,,,percent of total billed charges,24% of total billed charges ,87,24,,,percent of total billed charges,24% of total billed charges ,87,290,
BULLOUS PEMPHIGOID ANTIBODY 230,4199250,CDM,300,RC,83520,HCPCS,Outpatient,,,79.5,39.75,,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,63.6,80,,,percent of total billed charges,80% of total billed charges ,19.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,40.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,19.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,19.08,24,,,percent of total billed charges,24% of total billed charges ,24.8,31.2,,,percent of total billed charges,31.2% of total billed charges,63.6,80,,,percent of total billed charges,80% of total billed charges,19.08,24,,,percent of total billed charges,24% of total billed charges ,19.08,24,,,percent of total billed charges,24% of total billed charges ,16.28,63.6,
CYP2D6 GENE,4199716,CDM,310,RC,81226,HCPCS,Outpatient,,,1204,602,,40,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,288.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,963.2,80,,,percent of total billed charges,80% of total billed charges ,291.85,24.24,,,percent of total billed charges,24.24% of total billed charges ,606.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,903,75,,,percent of total billed charges,75% of total billed charges ,294.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,40,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,288.96,24,,,percent of total billed charges,24% of total billed charges ,375.65,31.2,,,percent of total billed charges,31.2% of total billed charges,963.2,80,,,percent of total billed charges,80% of total billed charges,288.96,24,,,percent of total billed charges,24% of total billed charges ,288.96,24,,,percent of total billed charges,24% of total billed charges ,40,963.2,
ALLERGY EVALUATION REG 3,4199760,CDM,300,RC,86003,HCPCS,Outpatient,,,212,106,,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,50.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,169.6,80,,,percent of total billed charges,80% of total billed charges ,51.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,106.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,51.9,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,50.88,24,,,percent of total billed charges,24% of total billed charges ,66.14,31.2,,,percent of total billed charges,31.2% of total billed charges,169.6,80,,,percent of total billed charges,80% of total billed charges,50.88,24,,,percent of total billed charges,24% of total billed charges ,50.88,24,,,percent of total billed charges,24% of total billed charges ,6.57,169.6,
CHEST 1 VIEW,4419906,CDM,324,RC,71045,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
XR FINGER,4420001,CDM,320,RC,73140,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
FINGERS LT,4420002,CDM,320,RC,73140,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
FINGERS RT,4420003,CDM,320,RC,73140,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
XR HAND 3 VWS,4420004,CDM,320,RC,73130,HCPCS,Outpatient,,,336,168,,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,268.8,80,,,percent of total billed charges,80% of total billed charges ,81.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,169.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,82.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,104.83,31.2,,,percent of total billed charges,31.2% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,268.8,
HAND LT,4420005,CDM,320,RC,73130,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
HAND RT,4420006,CDM,320,RC,73130,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
XR WRIST,4420007,CDM,320,RC,73110,HCPCS,Outpatient,,,336,168,,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,268.8,80,,,percent of total billed charges,80% of total billed charges ,81.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,169.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,82.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,104.83,31.2,,,percent of total billed charges,31.2% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,268.8,
WRIST LT,4420008,CDM,320,RC,73110,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
WRIST RT,4420009,CDM,320,RC,73110,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
XR FOREARM,4420010,CDM,320,RC,73090,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
FOREARM LT,4420011,CDM,320,RC,73090,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
FOREARM RT,4420012,CDM,320,RC,73090,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
XR ELBOW AP LAT OBLIQUE,4420013,CDM,320,RC,73080,HCPCS,Outpatient,,,336,168,,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,268.8,80,,,percent of total billed charges,80% of total billed charges ,81.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,169.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,82.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,104.83,31.2,,,percent of total billed charges,31.2% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,268.8,
HUMERUS LT,4420014,CDM,320,RC,73060,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
HUMERUS  RT,4420015,CDM,320,RC,73060,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
SHOULDER LT,4420016,CDM,320,RC,73030,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
SHOULDER RT,4420017,CDM,320,RC,73030,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
XR SCAPULA,4420018,CDM,320,RC,73010,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
SCAPULA LT,4420019,CDM,320,RC,73010,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
SCAPULA RT,4420020,CDM,320,RC,73010,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
BILATERAL AC JOINTS WWO WEIGHTS,4420021,CDM,320,RC,73050,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
XR CLAVICLE,4420022,CDM,320,RC,73000,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
CLAVICLE LT,4420023,CDM,320,RC,73000,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
CLAVICLE RT,4420024,CDM,320,RC,73000,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
SC JOINTS STERNOCLAVICULAR JOINTS,4420025,CDM,320,RC,71130,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
XR STERNOCLAVICULAR JOINTS LT,4420026,CDM,320,RC,71130,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
XR STERNOCLAVICULAR JOINTS RT,4420027,CDM,320,RC,71130,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
XR UNSPECIFIED BODY REGION FLUOROSCOPY 1,4420028,CDM,320,RC,76000,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
XR UNSPECIFIED BODY REGION FLUOROSCOPY G,4420029,CDM,320,RC,76000,HCPCS,Outpatient,,,336,168,,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,268.8,80,,,percent of total billed charges,80% of total billed charges ,81.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,169.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,82.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,104.83,31.2,,,percent of total billed charges,31.2% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,268.8,
XR FLUORO GUIDE FOR NEEDLE LOCAL,4420030,CDM,320,RC,77002,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
CERVICAL SPINE 3 VIEWS OR LESS,4420031,CDM,320,RC,72040,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
XR ELBOW LT 3 VWS,4420032,CDM,320,RC,73070,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
ELBOW LT,4420033,CDM,320,RC,73070,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
ELBOW RT,4420034,CDM,320,RC,73070,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
XR WRIST 2 VIEWS,4420035,CDM,320,RC,73100,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
XR HAND 2 VWS,4420036,CDM,320,RC,73120,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
XR KNEE AP LATERAL,4420037,CDM,320,RC,73560,HCPCS,Outpatient,,,336,168,,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,268.8,80,,,percent of total billed charges,80% of total billed charges ,81.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,169.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,82.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,104.83,31.2,,,percent of total billed charges,31.2% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,268.8,
XR ANKLE AP LAT,4420038,CDM,320,RC,73600,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
XR FOOT 2 VWS,4420039,CDM,320,RC,73620,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
XR ABD AP SUPINE UPRIGHT,4420040,CDM,320,RC,74021,HCPCS,Outpatient,,,336,168,,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,268.8,80,,,percent of total billed charges,80% of total billed charges ,81.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,169.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,82.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,104.83,31.2,,,percent of total billed charges,31.2% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,268.8,
BILATERAL STANDING KNEES,4420041,CDM,320,RC,73565,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
XR TOES,4420042,CDM,320,RC,73660,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
TOES LT,4420043,CDM,320,RC,73660,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
TOES RT,4420044,CDM,320,RC,73660,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
XR FOOT 3 VWS,4420045,CDM,320,RC,73630,HCPCS,Outpatient,,,336,168,,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,268.8,80,,,percent of total billed charges,80% of total billed charges ,81.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,169.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,82.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,104.83,31.2,,,percent of total billed charges,31.2% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,268.8,
FOOT LT,4420046,CDM,320,RC,73630,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
FOOT RT,4420047,CDM,320,RC,73630,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
XR CALCANEUS SINGLE VW,4420048,CDM,320,RC,73650,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
HEEL LT,4420049,CDM,320,RC,73650,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
HEEL RT,4420050,CDM,320,RC,73650,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
XR ANKLE 3 VWS,4420051,CDM,320,RC,73610,HCPCS,Outpatient,,,336,168,,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,268.8,80,,,percent of total billed charges,80% of total billed charges ,81.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,169.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,82.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,104.83,31.2,,,percent of total billed charges,31.2% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,268.8,
ANKLE LT,4420052,CDM,320,RC,73610,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
ANKLE RT,4420053,CDM,320,RC,73610,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
XR TIBIA FIBULA,4420054,CDM,320,RC,73590,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
TIB FIB LT,4420055,CDM,320,RC,73590,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
TIB FIB RT,4420056,CDM,320,RC,73590,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
XR KNEE 3 VWS,4420057,CDM,320,RC,73562,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
KNEE LT,4420058,CDM,320,RC,73562,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
KNEE RT,4420059,CDM,320,RC,73562,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
XR FEMUR,4420060,CDM,320,RC,73552,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
FEMUR LT,4420061,CDM,320,RC,73552,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
FEMUR RT,4420062,CDM,320,RC,73552,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
XR HIP 2 VWS,4420063,CDM,320,RC,73502,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
HIP LT,4420064,CDM,320,RC,73502,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
HIP RT,4420065,CDM,320,RC,73502,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
XR PELVIS 3 VIEWS,4420066,CDM,320,RC,72190,HCPCS,Outpatient,,,336,168,,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,268.8,80,,,percent of total billed charges,80% of total billed charges ,81.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,169.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,82.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,104.83,31.2,,,percent of total billed charges,31.2% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,268.8,
SI JOINTS,4420067,CDM,320,RC,72202,HCPCS,Outpatient,,,310,155,,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,74.4,24,,,percent of total billed charges,24% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,248,80,,,percent of total billed charges,80% of total billed charges ,75.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,156.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,75.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,74.4,24,,,percent of total billed charges,24% of total billed charges ,96.72,31.2,,,percent of total billed charges,31.2% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,74.4,24,,,percent of total billed charges,24% of total billed charges ,74.4,24,,,percent of total billed charges,24% of total billed charges ,74.4,248,
XR SACROILIAC JOINT LT,4420068,CDM,320,RC,72202,HCPCS,Outpatient,,,292,146,,78.43,26.86,,,percent of total billed charges,26.86% of total billed charges,219,75,,,percent of total billed charges,75% of total billed charges ,219,75,,,percent of total billed charges,75% of total billed charges ,70.08,24,,,percent of total billed charges,24% of total billed charges ,219,75,,,percent of total billed charges,75% of total billed charges ,219,75,,,percent of total billed charges,75% of total billed charges ,233.6,80,,,percent of total billed charges,80% of total billed charges ,70.78,24.24,,,percent of total billed charges,24.24% of total billed charges ,147.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,219,75,,,percent of total billed charges,75% of total billed charges ,71.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,78.43,26.86,,,percent of total billed charges,26.86% of total billed charges,70.08,24,,,percent of total billed charges,24% of total billed charges ,91.1,31.2,,,percent of total billed charges,31.2% of total billed charges,233.6,80,,,percent of total billed charges,80% of total billed charges,70.08,24,,,percent of total billed charges,24% of total billed charges ,70.08,24,,,percent of total billed charges,24% of total billed charges ,70.08,233.6,
XR SACROILIAC JOINT RT,4420069,CDM,320,RC,72202,HCPCS,Outpatient,,,292,146,,78.43,26.86,,,percent of total billed charges,26.86% of total billed charges,219,75,,,percent of total billed charges,75% of total billed charges ,219,75,,,percent of total billed charges,75% of total billed charges ,70.08,24,,,percent of total billed charges,24% of total billed charges ,219,75,,,percent of total billed charges,75% of total billed charges ,219,75,,,percent of total billed charges,75% of total billed charges ,233.6,80,,,percent of total billed charges,80% of total billed charges ,70.78,24.24,,,percent of total billed charges,24.24% of total billed charges ,147.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,219,75,,,percent of total billed charges,75% of total billed charges ,71.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,78.43,26.86,,,percent of total billed charges,26.86% of total billed charges,70.08,24,,,percent of total billed charges,24% of total billed charges ,91.1,31.2,,,percent of total billed charges,31.2% of total billed charges,233.6,80,,,percent of total billed charges,80% of total billed charges,70.08,24,,,percent of total billed charges,24% of total billed charges ,70.08,24,,,percent of total billed charges,24% of total billed charges ,70.08,233.6,
SOFT TISSUE NECK,4420070,CDM,320,RC,70360,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
CERVICAL SPINE COMPLETE,4420071,CDM,320,RC,72050,HCPCS,Outpatient,,,682,341,,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,545.6,80,,,percent of total billed charges,80% of total billed charges ,165.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,343.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,166.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,212.78,31.2,,,percent of total billed charges,31.2% of total billed charges,545.6,80,,,percent of total billed charges,80% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,545.6,
THORACIC SPINE,4420072,CDM,320,RC,72070,HCPCS,Outpatient,,,545,272.5,,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,436,80,,,percent of total billed charges,80% of total billed charges ,132.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,274.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,133.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,170.04,31.2,,,percent of total billed charges,31.2% of total billed charges,436,80,,,percent of total billed charges,80% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,436,
XR SACRUM,4420073,CDM,320,RC,72220,HCPCS,Outpatient,,,223,111.5,,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,178.4,80,,,percent of total billed charges,80% of total billed charges ,54.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,112.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,167.25,75,,,percent of total billed charges,75% of total billed charges ,54.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.9,26.86,,,percent of total billed charges,26.86% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,69.58,31.2,,,percent of total billed charges,31.2% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,24,,,percent of total billed charges,24% of total billed charges ,53.52,178.4,
SACRUM AND OR COCCYX,4420074,CDM,320,RC,72220,HCPCS,Outpatient,,,272,136,,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,217.6,80,,,percent of total billed charges,80% of total billed charges ,65.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,204,75,,,percent of total billed charges,75% of total billed charges ,66.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.06,26.86,,,percent of total billed charges,26.86% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,84.86,31.2,,,percent of total billed charges,31.2% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,24,,,percent of total billed charges,24% of total billed charges ,65.28,217.6,
LUMBAR SPINE 2 OR 3 VIEWS,4420075,CDM,320,RC,72100,HCPCS,Outpatient,,,323.5,161.75,,86.89,26.86,,,percent of total billed charges,26.86% of total billed charges,242.63,75,,,percent of total billed charges,75% of total billed charges ,242.63,75,,,percent of total billed charges,75% of total billed charges ,77.64,24,,,percent of total billed charges,24% of total billed charges ,242.63,75,,,percent of total billed charges,75% of total billed charges ,242.63,75,,,percent of total billed charges,75% of total billed charges ,258.8,80,,,percent of total billed charges,80% of total billed charges ,78.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,163.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,242.63,75,,,percent of total billed charges,75% of total billed charges ,79.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,86.89,26.86,,,percent of total billed charges,26.86% of total billed charges,77.64,24,,,percent of total billed charges,24% of total billed charges ,100.93,31.2,,,percent of total billed charges,31.2% of total billed charges,258.8,80,,,percent of total billed charges,80% of total billed charges,77.64,24,,,percent of total billed charges,24% of total billed charges ,77.64,24,,,percent of total billed charges,24% of total billed charges ,77.64,258.8,
SKULL COMPLETE,4420076,CDM,320,RC,70260,HCPCS,Outpatient,,,356.5,178.25,,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,285.2,
ORBITS COMPLETE,4420077,CDM,320,RC,70200,HCPCS,Outpatient,,,356.5,178.25,,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,285.2,
XR ORBIT LT,4420078,CDM,320,RC,70200,HCPCS,Outpatient,,,336,168,,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,268.8,80,,,percent of total billed charges,80% of total billed charges ,81.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,169.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,82.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,104.83,31.2,,,percent of total billed charges,31.2% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,268.8,
XR ORBIT RT,4420079,CDM,320,RC,70200,HCPCS,Outpatient,,,336,168,,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,268.8,80,,,percent of total billed charges,80% of total billed charges ,81.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,169.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,82.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,104.83,31.2,,,percent of total billed charges,31.2% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,268.8,
FACIAL BONES COMPLETE,4420080,CDM,320,RC,70150,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
MANDIBLE COMPLETE,4420081,CDM,320,RC,70110,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
MASTOIDS COMPLETE,4420082,CDM,320,RC,70130,HCPCS,Outpatient,,,356.5,178.25,,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,285.2,
NASAL BONES,4420083,CDM,320,RC,70160,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
SINUSES COMPLETE,4420084,CDM,320,RC,70220,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
BILATERAL TMJ,4420085,CDM,320,RC,70328,HCPCS,Outpatient,,,356.5,178.25,,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,285.2,
MASTOIDS LESS THAN THREE VIEWS,4420086,CDM,320,RC,70120,HCPCS,Outpatient,,,148.5,74.25,,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,35.64,24,,,percent of total billed charges,24% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,118.8,80,,,percent of total billed charges,80% of total billed charges ,36,24.24,,,percent of total billed charges,24.24% of total billed charges ,74.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,36.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,35.64,24,,,percent of total billed charges,24% of total billed charges ,46.33,31.2,,,percent of total billed charges,31.2% of total billed charges,118.8,80,,,percent of total billed charges,80% of total billed charges,35.64,24,,,percent of total billed charges,24% of total billed charges ,35.64,24,,,percent of total billed charges,24% of total billed charges ,35.64,118.8,
FACIAL BONES LESS THAN 3 VIEWS,4420088,CDM,320,RC,70140,HCPCS,Outpatient,,,190.5,95.25,,51.17,26.86,,,percent of total billed charges,26.86% of total billed charges,142.88,75,,,percent of total billed charges,75% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,45.72,24,,,percent of total billed charges,24% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,152.4,80,,,percent of total billed charges,80% of total billed charges ,46.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,96.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,46.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,51.17,26.86,,,percent of total billed charges,26.86% of total billed charges,45.72,24,,,percent of total billed charges,24% of total billed charges ,59.44,31.2,,,percent of total billed charges,31.2% of total billed charges,152.4,80,,,percent of total billed charges,80% of total billed charges,45.72,24,,,percent of total billed charges,24% of total billed charges ,45.72,24,,,percent of total billed charges,24% of total billed charges ,45.72,152.4,
SINUSES LESS THAN THREE VIEWS,4420089,CDM,320,RC,70210,HCPCS,Outpatient,,,190.5,95.25,,51.17,26.86,,,percent of total billed charges,26.86% of total billed charges,142.88,75,,,percent of total billed charges,75% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,45.72,24,,,percent of total billed charges,24% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,152.4,80,,,percent of total billed charges,80% of total billed charges ,46.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,96.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,46.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,51.17,26.86,,,percent of total billed charges,26.86% of total billed charges,45.72,24,,,percent of total billed charges,24% of total billed charges ,59.44,31.2,,,percent of total billed charges,31.2% of total billed charges,152.4,80,,,percent of total billed charges,80% of total billed charges,45.72,24,,,percent of total billed charges,24% of total billed charges ,45.72,24,,,percent of total billed charges,24% of total billed charges ,45.72,152.4,
SKULL LESS THAN FOUR VIEW,4420090,CDM,320,RC,70250,HCPCS,Outpatient,,,219.5,109.75,,58.96,26.86,,,percent of total billed charges,26.86% of total billed charges,164.63,75,,,percent of total billed charges,75% of total billed charges ,164.63,75,,,percent of total billed charges,75% of total billed charges ,52.68,24,,,percent of total billed charges,24% of total billed charges ,164.63,75,,,percent of total billed charges,75% of total billed charges ,164.63,75,,,percent of total billed charges,75% of total billed charges ,175.6,80,,,percent of total billed charges,80% of total billed charges ,53.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,110.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,164.63,75,,,percent of total billed charges,75% of total billed charges ,53.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,58.96,26.86,,,percent of total billed charges,26.86% of total billed charges,52.68,24,,,percent of total billed charges,24% of total billed charges ,68.48,31.2,,,percent of total billed charges,31.2% of total billed charges,175.6,80,,,percent of total billed charges,80% of total billed charges,52.68,24,,,percent of total billed charges,24% of total billed charges ,52.68,24,,,percent of total billed charges,24% of total billed charges ,52.68,175.6,
UNILATERAL TMJ RT,4420091,CDM,320,RC,70328,HCPCS,Outpatient,,,202,101,,54.26,26.86,,,percent of total billed charges,26.86% of total billed charges,151.5,75,,,percent of total billed charges,75% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,48.48,24,,,percent of total billed charges,24% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,161.6,80,,,percent of total billed charges,80% of total billed charges ,48.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,101.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,49.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,54.26,26.86,,,percent of total billed charges,26.86% of total billed charges,48.48,24,,,percent of total billed charges,24% of total billed charges ,63.02,31.2,,,percent of total billed charges,31.2% of total billed charges,161.6,80,,,percent of total billed charges,80% of total billed charges,48.48,24,,,percent of total billed charges,24% of total billed charges ,48.48,24,,,percent of total billed charges,24% of total billed charges ,48.48,161.6,
UNILATERAL TMJ LT,4420092,CDM,320,RC,70328,HCPCS,Outpatient,,,202,101,,54.26,26.86,,,percent of total billed charges,26.86% of total billed charges,151.5,75,,,percent of total billed charges,75% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,48.48,24,,,percent of total billed charges,24% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,161.6,80,,,percent of total billed charges,80% of total billed charges ,48.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,101.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,49.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,54.26,26.86,,,percent of total billed charges,26.86% of total billed charges,48.48,24,,,percent of total billed charges,24% of total billed charges ,63.02,31.2,,,percent of total billed charges,31.2% of total billed charges,161.6,80,,,percent of total billed charges,80% of total billed charges,48.48,24,,,percent of total billed charges,24% of total billed charges ,48.48,24,,,percent of total billed charges,24% of total billed charges ,48.48,161.6,
UNILATERAL RIBS 3 VIEW LT,4420094,CDM,320,RC,71101,HCPCS,Outpatient,,,323.5,161.75,,86.89,26.86,,,percent of total billed charges,26.86% of total billed charges,242.63,75,,,percent of total billed charges,75% of total billed charges ,242.63,75,,,percent of total billed charges,75% of total billed charges ,77.64,24,,,percent of total billed charges,24% of total billed charges ,242.63,75,,,percent of total billed charges,75% of total billed charges ,242.63,75,,,percent of total billed charges,75% of total billed charges ,258.8,80,,,percent of total billed charges,80% of total billed charges ,78.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,163.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,242.63,75,,,percent of total billed charges,75% of total billed charges ,79.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,86.89,26.86,,,percent of total billed charges,26.86% of total billed charges,77.64,24,,,percent of total billed charges,24% of total billed charges ,100.93,31.2,,,percent of total billed charges,31.2% of total billed charges,258.8,80,,,percent of total billed charges,80% of total billed charges,77.64,24,,,percent of total billed charges,24% of total billed charges ,77.64,24,,,percent of total billed charges,24% of total billed charges ,77.64,258.8,
UNILATERAL RIBS 3 VIEWS RT,4420095,CDM,320,RC,71101,HCPCS,Outpatient,,,323.5,161.75,,86.89,26.86,,,percent of total billed charges,26.86% of total billed charges,242.63,75,,,percent of total billed charges,75% of total billed charges ,242.63,75,,,percent of total billed charges,75% of total billed charges ,77.64,24,,,percent of total billed charges,24% of total billed charges ,242.63,75,,,percent of total billed charges,75% of total billed charges ,242.63,75,,,percent of total billed charges,75% of total billed charges ,258.8,80,,,percent of total billed charges,80% of total billed charges ,78.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,163.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,242.63,75,,,percent of total billed charges,75% of total billed charges ,79.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,86.89,26.86,,,percent of total billed charges,26.86% of total billed charges,77.64,24,,,percent of total billed charges,24% of total billed charges ,100.93,31.2,,,percent of total billed charges,31.2% of total billed charges,258.8,80,,,percent of total billed charges,80% of total billed charges,77.64,24,,,percent of total billed charges,24% of total billed charges ,77.64,24,,,percent of total billed charges,24% of total billed charges ,77.64,258.8,
BILATERAL RIBS 4 VIEWS,4420096,CDM,320,RC,71111,HCPCS,Outpatient,,,345,172.5,,92.67,26.86,,,percent of total billed charges,26.86% of total billed charges,258.75,75,,,percent of total billed charges,75% of total billed charges ,258.75,75,,,percent of total billed charges,75% of total billed charges ,82.8,24,,,percent of total billed charges,24% of total billed charges ,258.75,75,,,percent of total billed charges,75% of total billed charges ,258.75,75,,,percent of total billed charges,75% of total billed charges ,276,80,,,percent of total billed charges,80% of total billed charges ,83.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,173.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,258.75,75,,,percent of total billed charges,75% of total billed charges ,84.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,92.67,26.86,,,percent of total billed charges,26.86% of total billed charges,82.8,24,,,percent of total billed charges,24% of total billed charges ,107.64,31.2,,,percent of total billed charges,31.2% of total billed charges,276,80,,,percent of total billed charges,80% of total billed charges,82.8,24,,,percent of total billed charges,24% of total billed charges ,82.8,24,,,percent of total billed charges,24% of total billed charges ,82.8,276,
SCOLIOSIS SPINE,4420097,CDM,320,RC,72081,HCPCS,Outpatient,,,254.5,127.25,,68.36,26.86,,,percent of total billed charges,26.86% of total billed charges,190.88,75,,,percent of total billed charges,75% of total billed charges ,190.88,75,,,percent of total billed charges,75% of total billed charges ,61.08,24,,,percent of total billed charges,24% of total billed charges ,190.88,75,,,percent of total billed charges,75% of total billed charges ,190.88,75,,,percent of total billed charges,75% of total billed charges ,203.6,80,,,percent of total billed charges,80% of total billed charges ,61.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,128.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,190.88,75,,,percent of total billed charges,75% of total billed charges ,62.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,68.36,26.86,,,percent of total billed charges,26.86% of total billed charges,61.08,24,,,percent of total billed charges,24% of total billed charges ,79.4,31.2,,,percent of total billed charges,31.2% of total billed charges,203.6,80,,,percent of total billed charges,80% of total billed charges,61.08,24,,,percent of total billed charges,24% of total billed charges ,61.08,24,,,percent of total billed charges,24% of total billed charges ,61.08,203.6,
LUMBAR SPINE WITH FLEX AND EXT VIEWS,4420098,CDM,320,RC,72114,HCPCS,Outpatient,,,586,293,,157.4,26.86,,,percent of total billed charges,26.86% of total billed charges,439.5,75,,,percent of total billed charges,75% of total billed charges ,439.5,75,,,percent of total billed charges,75% of total billed charges ,140.64,24,,,percent of total billed charges,24% of total billed charges ,439.5,75,,,percent of total billed charges,75% of total billed charges ,439.5,75,,,percent of total billed charges,75% of total billed charges ,468.8,80,,,percent of total billed charges,80% of total billed charges ,142.05,24.24,,,percent of total billed charges,24.24% of total billed charges ,295.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,439.5,75,,,percent of total billed charges,75% of total billed charges ,143.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,157.4,26.86,,,percent of total billed charges,26.86% of total billed charges,140.64,24,,,percent of total billed charges,24% of total billed charges ,182.83,31.2,,,percent of total billed charges,31.2% of total billed charges,468.8,80,,,percent of total billed charges,80% of total billed charges,140.64,24,,,percent of total billed charges,24% of total billed charges ,140.64,24,,,percent of total billed charges,24% of total billed charges ,140.64,468.8,
PELVIS,4420099,CDM,320,RC,72170,HCPCS,Outpatient,,,219.5,109.75,,58.96,26.86,,,percent of total billed charges,26.86% of total billed charges,164.63,75,,,percent of total billed charges,75% of total billed charges ,164.63,75,,,percent of total billed charges,75% of total billed charges ,52.68,24,,,percent of total billed charges,24% of total billed charges ,164.63,75,,,percent of total billed charges,75% of total billed charges ,164.63,75,,,percent of total billed charges,75% of total billed charges ,175.6,80,,,percent of total billed charges,80% of total billed charges ,53.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,110.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,164.63,75,,,percent of total billed charges,75% of total billed charges ,53.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,58.96,26.86,,,percent of total billed charges,26.86% of total billed charges,52.68,24,,,percent of total billed charges,24% of total billed charges ,68.48,31.2,,,percent of total billed charges,31.2% of total billed charges,175.6,80,,,percent of total billed charges,80% of total billed charges,52.68,24,,,percent of total billed charges,24% of total billed charges ,52.68,24,,,percent of total billed charges,24% of total billed charges ,52.68,175.6,
XR UPPER EXT,4420100,CDM,320,RC,73092,HCPCS,Outpatient,,,125,62.5,,33.58,26.86,,,percent of total billed charges,26.86% of total billed charges,93.75,75,,,percent of total billed charges,75% of total billed charges ,93.75,75,,,percent of total billed charges,75% of total billed charges ,30,24,,,percent of total billed charges,24% of total billed charges ,93.75,75,,,percent of total billed charges,75% of total billed charges ,93.75,75,,,percent of total billed charges,75% of total billed charges ,100,80,,,percent of total billed charges,80% of total billed charges ,30.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,63,50.4,,,percent of total billed charges,50.4% of total billed charges ,93.75,75,,,percent of total billed charges,75% of total billed charges ,30.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,33.58,26.86,,,percent of total billed charges,26.86% of total billed charges,30,24,,,percent of total billed charges,24% of total billed charges ,39,31.2,,,percent of total billed charges,31.2% of total billed charges,100,80,,,percent of total billed charges,80% of total billed charges,30,24,,,percent of total billed charges,24% of total billed charges ,30,24,,,percent of total billed charges,24% of total billed charges ,30,100,
UPPER EXTREMITY INFANT LT,4420101,CDM,320,RC,73092,HCPCS,Outpatient,,,133,66.5,,35.72,26.86,,,percent of total billed charges,26.86% of total billed charges,99.75,75,,,percent of total billed charges,75% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,31.92,24,,,percent of total billed charges,24% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,106.4,80,,,percent of total billed charges,80% of total billed charges ,32.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,67.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,32.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.72,26.86,,,percent of total billed charges,26.86% of total billed charges,31.92,24,,,percent of total billed charges,24% of total billed charges ,41.5,31.2,,,percent of total billed charges,31.2% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,31.92,24,,,percent of total billed charges,24% of total billed charges ,31.92,24,,,percent of total billed charges,24% of total billed charges ,31.92,106.4,
UPPER EXTREMITY INFANT RT,4420102,CDM,320,RC,73092,HCPCS,Outpatient,,,133,66.5,,35.72,26.86,,,percent of total billed charges,26.86% of total billed charges,99.75,75,,,percent of total billed charges,75% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,31.92,24,,,percent of total billed charges,24% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,106.4,80,,,percent of total billed charges,80% of total billed charges ,32.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,67.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,99.75,75,,,percent of total billed charges,75% of total billed charges ,32.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.72,26.86,,,percent of total billed charges,26.86% of total billed charges,31.92,24,,,percent of total billed charges,24% of total billed charges ,41.5,31.2,,,percent of total billed charges,31.2% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,31.92,24,,,percent of total billed charges,24% of total billed charges ,31.92,24,,,percent of total billed charges,24% of total billed charges ,31.92,106.4,
BILATERAL HIPS,4420103,CDM,320,RC,73521,HCPCS,Outpatient,,,466.5,233.25,,125.3,26.86,,,percent of total billed charges,26.86% of total billed charges,349.88,75,,,percent of total billed charges,75% of total billed charges ,349.88,75,,,percent of total billed charges,75% of total billed charges ,111.96,24,,,percent of total billed charges,24% of total billed charges ,349.88,75,,,percent of total billed charges,75% of total billed charges ,349.88,75,,,percent of total billed charges,75% of total billed charges ,373.2,80,,,percent of total billed charges,80% of total billed charges ,113.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,235.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,349.88,75,,,percent of total billed charges,75% of total billed charges ,114.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,125.3,26.86,,,percent of total billed charges,26.86% of total billed charges,111.96,24,,,percent of total billed charges,24% of total billed charges ,145.55,31.2,,,percent of total billed charges,31.2% of total billed charges,373.2,80,,,percent of total billed charges,80% of total billed charges,111.96,24,,,percent of total billed charges,24% of total billed charges ,111.96,24,,,percent of total billed charges,24% of total billed charges ,111.96,373.2,
INFANT PELVIS AND HIPS,4420104,CDM,320,RC,73501,HCPCS,Outpatient,,,244,122,,65.54,26.86,,,percent of total billed charges,26.86% of total billed charges,183,75,,,percent of total billed charges,75% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,58.56,24,,,percent of total billed charges,24% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,195.2,80,,,percent of total billed charges,80% of total billed charges ,59.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,122.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,59.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,65.54,26.86,,,percent of total billed charges,26.86% of total billed charges,58.56,24,,,percent of total billed charges,24% of total billed charges ,76.13,31.2,,,percent of total billed charges,31.2% of total billed charges,195.2,80,,,percent of total billed charges,80% of total billed charges,58.56,24,,,percent of total billed charges,24% of total billed charges ,58.56,24,,,percent of total billed charges,24% of total billed charges ,58.56,195.2,
XR LOWER EXT BILATERAL,4420105,CDM,320,RC,73592,HCPCS,Outpatient,,,140,70,,37.6,26.86,,,percent of total billed charges,26.86% of total billed charges,105,75,,,percent of total billed charges,75% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,33.6,24,,,percent of total billed charges,24% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,112,80,,,percent of total billed charges,80% of total billed charges ,33.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,70.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,34.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.6,26.86,,,percent of total billed charges,26.86% of total billed charges,33.6,24,,,percent of total billed charges,24% of total billed charges ,43.68,31.2,,,percent of total billed charges,31.2% of total billed charges,112,80,,,percent of total billed charges,80% of total billed charges,33.6,24,,,percent of total billed charges,24% of total billed charges ,33.6,24,,,percent of total billed charges,24% of total billed charges ,33.6,112,
LOWER EXTREMITY INFANT LT,4420106,CDM,320,RC,73592,HCPCS,Outpatient,,,148.5,74.25,,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,35.64,24,,,percent of total billed charges,24% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,118.8,80,,,percent of total billed charges,80% of total billed charges ,36,24.24,,,percent of total billed charges,24.24% of total billed charges ,74.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,36.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,35.64,24,,,percent of total billed charges,24% of total billed charges ,46.33,31.2,,,percent of total billed charges,31.2% of total billed charges,118.8,80,,,percent of total billed charges,80% of total billed charges,35.64,24,,,percent of total billed charges,24% of total billed charges ,35.64,24,,,percent of total billed charges,24% of total billed charges ,35.64,118.8,
LOWER EXTREMITY INFANT RT,4420107,CDM,320,RC,73592,HCPCS,Outpatient,,,148.5,74.25,,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,35.64,24,,,percent of total billed charges,24% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,118.8,80,,,percent of total billed charges,80% of total billed charges ,36,24.24,,,percent of total billed charges,24.24% of total billed charges ,74.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,36.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,35.64,24,,,percent of total billed charges,24% of total billed charges ,46.33,31.2,,,percent of total billed charges,31.2% of total billed charges,118.8,80,,,percent of total billed charges,80% of total billed charges,35.64,24,,,percent of total billed charges,24% of total billed charges ,35.64,24,,,percent of total billed charges,24% of total billed charges ,35.64,118.8,
UPPER GI SERIES WITH SMALL BOWEL FOLLOW,4420108,CDM,320,RC,74246,HCPCS,Outpatient,,,724,362,,194.47,26.86,,,percent of total billed charges,26.86% of total billed charges,543,75,,,percent of total billed charges,75% of total billed charges ,543,75,,,percent of total billed charges,75% of total billed charges ,173.76,24,,,percent of total billed charges,24% of total billed charges ,543,75,,,percent of total billed charges,75% of total billed charges ,543,75,,,percent of total billed charges,75% of total billed charges ,579.2,80,,,percent of total billed charges,80% of total billed charges ,175.5,24.24,,,percent of total billed charges,24.24% of total billed charges ,364.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,543,75,,,percent of total billed charges,75% of total billed charges ,177.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,194.47,26.86,,,percent of total billed charges,26.86% of total billed charges,173.76,24,,,percent of total billed charges,24% of total billed charges ,225.89,31.2,,,percent of total billed charges,31.2% of total billed charges,579.2,80,,,percent of total billed charges,80% of total billed charges,173.76,24,,,percent of total billed charges,24% of total billed charges ,173.76,24,,,percent of total billed charges,24% of total billed charges ,173.76,579.2,
NOSE TO RECTUM FORIGN BODY FOR CHILD,4420109,CDM,320,RC,76010,HCPCS,Outpatient,,,190.5,95.25,,51.17,26.86,,,percent of total billed charges,26.86% of total billed charges,142.88,75,,,percent of total billed charges,75% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,45.72,24,,,percent of total billed charges,24% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,152.4,80,,,percent of total billed charges,80% of total billed charges ,46.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,96.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,46.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,51.17,26.86,,,percent of total billed charges,26.86% of total billed charges,45.72,24,,,percent of total billed charges,24% of total billed charges ,59.44,31.2,,,percent of total billed charges,31.2% of total billed charges,152.4,80,,,percent of total billed charges,80% of total billed charges,45.72,24,,,percent of total billed charges,24% of total billed charges ,45.72,24,,,percent of total billed charges,24% of total billed charges ,45.72,152.4,
BONE LENGTH STUDIES,4420110,CDM,320,RC,77073,HCPCS,Outpatient,,,372,186,,99.92,26.86,,,percent of total billed charges,26.86% of total billed charges,279,75,,,percent of total billed charges,75% of total billed charges ,279,75,,,percent of total billed charges,75% of total billed charges ,89.28,24,,,percent of total billed charges,24% of total billed charges ,279,75,,,percent of total billed charges,75% of total billed charges ,279,75,,,percent of total billed charges,75% of total billed charges ,297.6,80,,,percent of total billed charges,80% of total billed charges ,90.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,187.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,279,75,,,percent of total billed charges,75% of total billed charges ,91.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,99.92,26.86,,,percent of total billed charges,26.86% of total billed charges,89.28,24,,,percent of total billed charges,24% of total billed charges ,116.06,31.2,,,percent of total billed charges,31.2% of total billed charges,297.6,80,,,percent of total billed charges,80% of total billed charges,89.28,24,,,percent of total billed charges,24% of total billed charges ,89.28,24,,,percent of total billed charges,24% of total billed charges ,89.28,297.6,
CHEST PA AND LATERAL,4420111,CDM,324,RC,71046,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
XR CHEST PA AP LAT DECUBIT,4420112,CDM,324,RC,71048,HCPCS,Outpatient,,,336,168,,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,268.8,80,,,percent of total billed charges,80% of total billed charges ,81.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,169.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,82.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,104.83,31.2,,,percent of total billed charges,31.2% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,268.8,
XR RIBS LATERAL,4420113,CDM,320,RC,71100,HCPCS,Outpatient,,,336,168,,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,268.8,80,,,percent of total billed charges,80% of total billed charges ,81.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,169.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,252,75,,,percent of total billed charges,75% of total billed charges ,82.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,90.25,26.86,,,percent of total billed charges,26.86% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,104.83,31.2,,,percent of total billed charges,31.2% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,24,,,percent of total billed charges,24% of total billed charges ,80.64,268.8,
XR RIBS BILATERAL,4420114,CDM,320,RC,71110,HCPCS,Outpatient,,,447,223.5,,120.06,26.86,,,percent of total billed charges,26.86% of total billed charges,335.25,75,,,percent of total billed charges,75% of total billed charges ,335.25,75,,,percent of total billed charges,75% of total billed charges ,107.28,24,,,percent of total billed charges,24% of total billed charges ,335.25,75,,,percent of total billed charges,75% of total billed charges ,335.25,75,,,percent of total billed charges,75% of total billed charges ,357.6,80,,,percent of total billed charges,80% of total billed charges ,108.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,225.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,335.25,75,,,percent of total billed charges,75% of total billed charges ,109.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,120.06,26.86,,,percent of total billed charges,26.86% of total billed charges,107.28,24,,,percent of total billed charges,24% of total billed charges ,139.46,31.2,,,percent of total billed charges,31.2% of total billed charges,357.6,80,,,percent of total billed charges,80% of total billed charges,107.28,24,,,percent of total billed charges,24% of total billed charges ,107.28,24,,,percent of total billed charges,24% of total billed charges ,107.28,357.6,
STERNUM,4420115,CDM,320,RC,71120,HCPCS,Outpatient,,,356.5,178.25,,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,285.2,
DEXA BONE DENSITY SCAN,4420116,CDM,320,RC,77080,HCPCS,Outpatient,,,701.5,350.75,,188.42,26.86,,,percent of total billed charges,26.86% of total billed charges,526.13,75,,,percent of total billed charges,75% of total billed charges ,526.13,75,,,percent of total billed charges,75% of total billed charges ,168.36,24,,,percent of total billed charges,24% of total billed charges ,526.13,75,,,percent of total billed charges,75% of total billed charges ,526.13,75,,,percent of total billed charges,75% of total billed charges ,561.2,80,,,percent of total billed charges,80% of total billed charges ,170.04,24.24,,,percent of total billed charges,24.24% of total billed charges ,353.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,526.13,75,,,percent of total billed charges,75% of total billed charges ,171.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,188.42,26.86,,,percent of total billed charges,26.86% of total billed charges,168.36,24,,,percent of total billed charges,24% of total billed charges ,218.87,31.2,,,percent of total billed charges,31.2% of total billed charges,561.2,80,,,percent of total billed charges,80% of total billed charges,168.36,24,,,percent of total billed charges,24% of total billed charges ,168.36,24,,,percent of total billed charges,24% of total billed charges ,168.36,561.2,
KUB SINGLE VIEW,4420117,CDM,320,RC,74018,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
ABDOMEN SERIES W/PA CHEST,4420118,CDM,320,RC,74022,HCPCS,Outpatient,,,545,272.5,,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,436,80,,,percent of total billed charges,80% of total billed charges ,132.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,274.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,133.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,170.04,31.2,,,percent of total billed charges,31.2% of total billed charges,436,80,,,percent of total billed charges,80% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,436,
XR ABD AP LAT,4420119,CDM,320,RC,74019,HCPCS,Outpatient,,,447,223.5,,120.06,26.86,,,percent of total billed charges,26.86% of total billed charges,335.25,75,,,percent of total billed charges,75% of total billed charges ,335.25,75,,,percent of total billed charges,75% of total billed charges ,107.28,24,,,percent of total billed charges,24% of total billed charges ,335.25,75,,,percent of total billed charges,75% of total billed charges ,335.25,75,,,percent of total billed charges,75% of total billed charges ,357.6,80,,,percent of total billed charges,80% of total billed charges ,108.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,225.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,335.25,75,,,percent of total billed charges,75% of total billed charges ,109.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,120.06,26.86,,,percent of total billed charges,26.86% of total billed charges,107.28,24,,,percent of total billed charges,24% of total billed charges ,139.46,31.2,,,percent of total billed charges,31.2% of total billed charges,357.6,80,,,percent of total billed charges,80% of total billed charges,107.28,24,,,percent of total billed charges,24% of total billed charges ,107.28,24,,,percent of total billed charges,24% of total billed charges ,107.28,357.6,
BONE AGE STUDIES,4420120,CDM,320,RC,77072,HCPCS,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
OSSEOUS BONE SURVEY COMPLETE FOR METASTI,4420121,CDM,320,RC,77075,HCPCS,Outpatient,,,818,409,,219.71,26.86,,,percent of total billed charges,26.86% of total billed charges,613.5,75,,,percent of total billed charges,75% of total billed charges ,613.5,75,,,percent of total billed charges,75% of total billed charges ,196.32,24,,,percent of total billed charges,24% of total billed charges ,613.5,75,,,percent of total billed charges,75% of total billed charges ,613.5,75,,,percent of total billed charges,75% of total billed charges ,654.4,80,,,percent of total billed charges,80% of total billed charges ,198.28,24.24,,,percent of total billed charges,24.24% of total billed charges ,412.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,613.5,75,,,percent of total billed charges,75% of total billed charges ,200.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,219.71,26.86,,,percent of total billed charges,26.86% of total billed charges,196.32,24,,,percent of total billed charges,24% of total billed charges ,255.22,31.2,,,percent of total billed charges,31.2% of total billed charges,654.4,80,,,percent of total billed charges,80% of total billed charges,196.32,24,,,percent of total billed charges,24% of total billed charges ,196.32,24,,,percent of total billed charges,24% of total billed charges ,196.32,654.4,
XR ESOPHAGUS FLUORO W BARIUM CONT,4420122,CDM,320,RC,74230,HCPCS,Outpatient,,,670,335,,179.96,26.86,,,percent of total billed charges,26.86% of total billed charges,502.5,75,,,percent of total billed charges,75% of total billed charges ,502.5,75,,,percent of total billed charges,75% of total billed charges ,160.8,24,,,percent of total billed charges,24% of total billed charges ,502.5,75,,,percent of total billed charges,75% of total billed charges ,502.5,75,,,percent of total billed charges,75% of total billed charges ,536,80,,,percent of total billed charges,80% of total billed charges ,162.41,24.24,,,percent of total billed charges,24.24% of total billed charges ,337.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,502.5,75,,,percent of total billed charges,75% of total billed charges ,164.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,179.96,26.86,,,percent of total billed charges,26.86% of total billed charges,160.8,24,,,percent of total billed charges,24% of total billed charges ,209.04,31.2,,,percent of total billed charges,31.2% of total billed charges,536,80,,,percent of total billed charges,80% of total billed charges,160.8,24,,,percent of total billed charges,24% of total billed charges ,160.8,24,,,percent of total billed charges,24% of total billed charges ,160.8,536,
BARIUM ENEMA,4420123,CDM,320,RC,74270,HCPCS,Outpatient,,,710.5,355.25,,190.84,26.86,,,percent of total billed charges,26.86% of total billed charges,532.88,75,,,percent of total billed charges,75% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,170.52,24,,,percent of total billed charges,24% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,568.4,80,,,percent of total billed charges,80% of total billed charges ,172.23,24.24,,,percent of total billed charges,24.24% of total billed charges ,358.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,173.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,190.84,26.86,,,percent of total billed charges,26.86% of total billed charges,170.52,24,,,percent of total billed charges,24% of total billed charges ,221.68,31.2,,,percent of total billed charges,31.2% of total billed charges,568.4,80,,,percent of total billed charges,80% of total billed charges,170.52,24,,,percent of total billed charges,24% of total billed charges ,170.52,24,,,percent of total billed charges,24% of total billed charges ,170.52,568.4,
XR BARIUM ENEMA WITH AIR CONTRAST,4420124,CDM,320,RC,74280,HCPCS,Outpatient,,,894,447,,240.13,26.86,,,percent of total billed charges,26.86% of total billed charges,670.5,75,,,percent of total billed charges,75% of total billed charges ,670.5,75,,,percent of total billed charges,75% of total billed charges ,214.56,24,,,percent of total billed charges,24% of total billed charges ,670.5,75,,,percent of total billed charges,75% of total billed charges ,670.5,75,,,percent of total billed charges,75% of total billed charges ,715.2,80,,,percent of total billed charges,80% of total billed charges ,216.71,24.24,,,percent of total billed charges,24.24% of total billed charges ,450.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,670.5,75,,,percent of total billed charges,75% of total billed charges ,218.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,240.13,26.86,,,percent of total billed charges,26.86% of total billed charges,214.56,24,,,percent of total billed charges,24% of total billed charges ,278.93,31.2,,,percent of total billed charges,31.2% of total billed charges,715.2,80,,,percent of total billed charges,80% of total billed charges,214.56,24,,,percent of total billed charges,24% of total billed charges ,214.56,24,,,percent of total billed charges,24% of total billed charges ,214.56,715.2,
UPPER GI SERIES WITH KUB,4420125,CDM,320,RC,74246,HCPCS,Outpatient,,,710.5,355.25,,190.84,26.86,,,percent of total billed charges,26.86% of total billed charges,532.88,75,,,percent of total billed charges,75% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,170.52,24,,,percent of total billed charges,24% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,568.4,80,,,percent of total billed charges,80% of total billed charges ,172.23,24.24,,,percent of total billed charges,24.24% of total billed charges ,358.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,173.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,190.84,26.86,,,percent of total billed charges,26.86% of total billed charges,170.52,24,,,percent of total billed charges,24% of total billed charges ,221.68,31.2,,,percent of total billed charges,31.2% of total billed charges,568.4,80,,,percent of total billed charges,80% of total billed charges,170.52,24,,,percent of total billed charges,24% of total billed charges ,170.52,24,,,percent of total billed charges,24% of total billed charges ,170.52,568.4,
SMALL BOWEL FOLLOW THROUGH,4420126,CDM,320,RC,74250,HCPCS,Outpatient,,,818,409,,219.71,26.86,,,percent of total billed charges,26.86% of total billed charges,613.5,75,,,percent of total billed charges,75% of total billed charges ,613.5,75,,,percent of total billed charges,75% of total billed charges ,196.32,24,,,percent of total billed charges,24% of total billed charges ,613.5,75,,,percent of total billed charges,75% of total billed charges ,613.5,75,,,percent of total billed charges,75% of total billed charges ,654.4,80,,,percent of total billed charges,80% of total billed charges ,198.28,24.24,,,percent of total billed charges,24.24% of total billed charges ,412.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,613.5,75,,,percent of total billed charges,75% of total billed charges ,200.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,219.71,26.86,,,percent of total billed charges,26.86% of total billed charges,196.32,24,,,percent of total billed charges,24% of total billed charges ,255.22,31.2,,,percent of total billed charges,31.2% of total billed charges,654.4,80,,,percent of total billed charges,80% of total billed charges,196.32,24,,,percent of total billed charges,24% of total billed charges ,196.32,24,,,percent of total billed charges,24% of total billed charges ,196.32,654.4,
BARIUM SWALLOW,4420127,CDM,320,RC,74210,HCPCS,Outpatient,,,710.5,355.25,,190.84,26.86,,,percent of total billed charges,26.86% of total billed charges,532.88,75,,,percent of total billed charges,75% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,170.52,24,,,percent of total billed charges,24% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,568.4,80,,,percent of total billed charges,80% of total billed charges ,172.23,24.24,,,percent of total billed charges,24.24% of total billed charges ,358.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,173.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,190.84,26.86,,,percent of total billed charges,26.86% of total billed charges,170.52,24,,,percent of total billed charges,24% of total billed charges ,221.68,31.2,,,percent of total billed charges,31.2% of total billed charges,568.4,80,,,percent of total billed charges,80% of total billed charges,170.52,24,,,percent of total billed charges,24% of total billed charges ,170.52,24,,,percent of total billed charges,24% of total billed charges ,170.52,568.4,
MANDIBLE LESS THAN 4 VIEWS,4420128,CDM,320,RC,70100,HCPCS,Outpatient,,,148.5,74.25,,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,35.64,24,,,percent of total billed charges,24% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,118.8,80,,,percent of total billed charges,80% of total billed charges ,36,24.24,,,percent of total billed charges,24.24% of total billed charges ,74.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,36.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,35.64,24,,,percent of total billed charges,24% of total billed charges ,46.33,31.2,,,percent of total billed charges,31.2% of total billed charges,118.8,80,,,percent of total billed charges,80% of total billed charges,35.64,24,,,percent of total billed charges,24% of total billed charges ,35.64,24,,,percent of total billed charges,24% of total billed charges ,35.64,118.8,
IVP,4420129,CDM,320,RC,74400,HCPCS,Outpatient,,,474,237,,127.32,26.86,,,percent of total billed charges,26.86% of total billed charges,355.5,75,,,percent of total billed charges,75% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,379.2,80,,,percent of total billed charges,80% of total billed charges ,114.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,238.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,116.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,127.32,26.86,,,percent of total billed charges,26.86% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,147.89,31.2,,,percent of total billed charges,31.2% of total billed charges,379.2,80,,,percent of total billed charges,80% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,379.2,
FLUORO  FOR ASPIRATION OF SPINAL FLUID,4420130,CDM,320,RC,62270,HCPCS,Outpatient,,,360.5,180.25,,96.83,26.86,,,percent of total billed charges,26.86% of total billed charges,270.38,75,,,percent of total billed charges,75% of total billed charges ,270.38,75,,,percent of total billed charges,75% of total billed charges ,86.52,24,,,percent of total billed charges,24% of total billed charges ,270.38,75,,,percent of total billed charges,75% of total billed charges ,270.38,75,,,percent of total billed charges,75% of total billed charges ,288.4,80,,,percent of total billed charges,80% of total billed charges ,87.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,181.69,50.4,,,percent of total billed charges,50.4% of total billed charges ,270.38,75,,,percent of total billed charges,75% of total billed charges ,88.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,96.83,26.86,,,percent of total billed charges,26.86% of total billed charges,86.52,24,,,percent of total billed charges,24% of total billed charges ,112.48,31.2,,,percent of total billed charges,31.2% of total billed charges,288.4,80,,,percent of total billed charges,80% of total billed charges,86.52,24,,,percent of total billed charges,24% of total billed charges ,86.52,24,,,percent of total billed charges,24% of total billed charges ,86.52,288.4,
XR HEAD NECK,4420131,CDM,402,RC,76536,HCPCS,Outpatient,,,447,223.5,,120.06,26.86,,,percent of total billed charges,26.86% of total billed charges,335.25,75,,,percent of total billed charges,75% of total billed charges ,335.25,75,,,percent of total billed charges,75% of total billed charges ,107.28,24,,,percent of total billed charges,24% of total billed charges ,335.25,75,,,percent of total billed charges,75% of total billed charges ,335.25,75,,,percent of total billed charges,75% of total billed charges ,357.6,80,,,percent of total billed charges,80% of total billed charges ,108.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,225.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,335.25,75,,,percent of total billed charges,75% of total billed charges ,109.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,120.06,26.86,,,percent of total billed charges,26.86% of total billed charges,107.28,24,,,percent of total billed charges,24% of total billed charges ,139.46,31.2,,,percent of total billed charges,31.2% of total billed charges,357.6,80,,,percent of total billed charges,80% of total billed charges,107.28,24,,,percent of total billed charges,24% of total billed charges ,107.28,24,,,percent of total billed charges,24% of total billed charges ,107.28,357.6,
MODIFIED BARIUM SWALLOW,4420132,CDM,320,RC,74230,HCPCS,Outpatient,,,710.5,355.25,,190.84,26.86,,,percent of total billed charges,26.86% of total billed charges,532.88,75,,,percent of total billed charges,75% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,170.52,24,,,percent of total billed charges,24% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,568.4,80,,,percent of total billed charges,80% of total billed charges ,172.23,24.24,,,percent of total billed charges,24.24% of total billed charges ,358.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,532.88,75,,,percent of total billed charges,75% of total billed charges ,173.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,190.84,26.86,,,percent of total billed charges,26.86% of total billed charges,170.52,24,,,percent of total billed charges,24% of total billed charges ,221.68,31.2,,,percent of total billed charges,31.2% of total billed charges,568.4,80,,,percent of total billed charges,80% of total billed charges,170.52,24,,,percent of total billed charges,24% of total billed charges ,170.52,24,,,percent of total billed charges,24% of total billed charges ,170.52,568.4,
SPINAL PUNCTURE LUMBARD DIAGNOSTIC,4420150,CDM,361,RC,62270,HCPCS,Outpatient,,,318.5,159.25,,85.55,26.86,,,percent of total billed charges,26.86% of total billed charges,238.88,75,,,percent of total billed charges,75% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,76.44,24,,,percent of total billed charges,24% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,254.8,80,,,percent of total billed charges,80% of total billed charges ,77.2,24.24,,,percent of total billed charges,24.24% of total billed charges ,160.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,77.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,85.55,26.86,,,percent of total billed charges,26.86% of total billed charges,76.44,24,,,percent of total billed charges,24% of total billed charges ,99.37,31.2,,,percent of total billed charges,31.2% of total billed charges,254.8,80,,,percent of total billed charges,80% of total billed charges,76.44,24,,,percent of total billed charges,24% of total billed charges ,76.44,24,,,percent of total billed charges,24% of total billed charges ,76.44,254.8,
ABDOMEN 2 VIEWS,4420189,CDM,320,RC,74019,HCPCS,Outpatient,,,545,272.5,,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,436,80,,,percent of total billed charges,80% of total billed charges ,132.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,274.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,133.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,170.04,31.2,,,percent of total billed charges,31.2% of total billed charges,436,80,,,percent of total billed charges,80% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,436,
ABDOMEN M OR MORE VIEWS,4420190,CDM,320,RC,74021,HCPCS,Outpatient,,,545,272.5,,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,436,80,,,percent of total billed charges,80% of total billed charges ,132.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,274.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,133.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,170.04,31.2,,,percent of total billed charges,31.2% of total billed charges,436,80,,,percent of total billed charges,80% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,436,
CHEST 3 VIEWS,4420199,CDM,324,RC,71047,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
CHEST 4 OR MORE VIEWS,4420200,CDM,324,RC,71048,HCPCS,Outpatient,,,410,205,,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,328,80,,,percent of total billed charges,80% of total billed charges ,99.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,206.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,307.5,75,,,percent of total billed charges,75% of total billed charges ,100.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.13,26.86,,,percent of total billed charges,26.86% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,127.92,31.2,,,percent of total billed charges,31.2% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,24,,,percent of total billed charges,24% of total billed charges ,98.4,328,
CERVICAL EPIDURAL STEROID INJECTION,4430000,CDM,361,RC,62321,HCPCS,Outpatient,,,1167,583.5,,313.46,26.86,,,percent of total billed charges,26.86% of total billed charges,875.25,75,,,percent of total billed charges,75% of total billed charges ,875.25,75,,,percent of total billed charges,75% of total billed charges ,280.08,24,,,percent of total billed charges,24% of total billed charges ,875.25,75,,,percent of total billed charges,75% of total billed charges ,875.25,75,,,percent of total billed charges,75% of total billed charges ,933.6,80,,,percent of total billed charges,80% of total billed charges ,282.88,24.24,,,percent of total billed charges,24.24% of total billed charges ,588.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,875.25,75,,,percent of total billed charges,75% of total billed charges ,285.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,313.46,26.86,,,percent of total billed charges,26.86% of total billed charges,280.08,24,,,percent of total billed charges,24% of total billed charges ,364.1,31.2,,,percent of total billed charges,31.2% of total billed charges,933.6,80,,,percent of total billed charges,80% of total billed charges,280.08,24,,,percent of total billed charges,24% of total billed charges ,280.08,24,,,percent of total billed charges,24% of total billed charges ,280.08,933.6,
LUMBAR EPIDURAL STEROID INJECTION,4430001,CDM,361,RC,64483,HCPCS,Outpatient,,,1167,583.5,,313.46,26.86,,,percent of total billed charges,26.86% of total billed charges,875.25,75,,,percent of total billed charges,75% of total billed charges ,875.25,75,,,percent of total billed charges,75% of total billed charges ,280.08,24,,,percent of total billed charges,24% of total billed charges ,875.25,75,,,percent of total billed charges,75% of total billed charges ,875.25,75,,,percent of total billed charges,75% of total billed charges ,933.6,80,,,percent of total billed charges,80% of total billed charges ,282.88,24.24,,,percent of total billed charges,24.24% of total billed charges ,588.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,875.25,75,,,percent of total billed charges,75% of total billed charges ,285.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,313.46,26.86,,,percent of total billed charges,26.86% of total billed charges,280.08,24,,,percent of total billed charges,24% of total billed charges ,364.1,31.2,,,percent of total billed charges,31.2% of total billed charges,933.6,80,,,percent of total billed charges,80% of total billed charges,280.08,24,,,percent of total billed charges,24% of total billed charges ,280.08,24,,,percent of total billed charges,24% of total billed charges ,280.08,933.6,
DEXA BODY COMPOSITION,4430003,CDM,320,RC,76499,HCPCS,Outpatient,,,125,62.5,,33.58,26.86,,,percent of total billed charges,26.86% of total billed charges,93.75,75,,,percent of total billed charges,75% of total billed charges ,93.75,75,,,percent of total billed charges,75% of total billed charges ,30,24,,,percent of total billed charges,24% of total billed charges ,93.75,75,,,percent of total billed charges,75% of total billed charges ,93.75,75,,,percent of total billed charges,75% of total billed charges ,100,80,,,percent of total billed charges,80% of total billed charges ,30.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,63,50.4,,,percent of total billed charges,50.4% of total billed charges ,93.75,75,,,percent of total billed charges,75% of total billed charges ,30.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,33.58,26.86,,,percent of total billed charges,26.86% of total billed charges,30,24,,,percent of total billed charges,24% of total billed charges ,39,31.2,,,percent of total billed charges,31.2% of total billed charges,100,80,,,percent of total billed charges,80% of total billed charges,30,24,,,percent of total billed charges,24% of total billed charges ,30,24,,,percent of total billed charges,24% of total billed charges ,30,100,
PARACENTESIS W IMAGING GUIDANCE,4430100,CDM,361,RC,49083,HCPCS,Outpatient,,,3713,1856.5,,997.31,26.86,,,percent of total billed charges,26.86% of total billed charges,2784.75,75,,,percent of total billed charges,75% of total billed charges ,2784.75,75,,,percent of total billed charges,75% of total billed charges ,891.12,24,,,percent of total billed charges,24% of total billed charges ,2784.75,75,,,percent of total billed charges,75% of total billed charges ,2784.75,75,,,percent of total billed charges,75% of total billed charges ,2970.4,80,,,percent of total billed charges,80% of total billed charges ,900.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,1871.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,2784.75,75,,,percent of total billed charges,75% of total billed charges ,908.94,24.48,,,percent of total billed charges,24.48% of total billed charges ,997.31,26.86,,,percent of total billed charges,26.86% of total billed charges,891.12,24,,,percent of total billed charges,24% of total billed charges ,1158.46,31.2,,,percent of total billed charges,31.2% of total billed charges,2970.4,80,,,percent of total billed charges,80% of total billed charges,891.12,24,,,percent of total billed charges,24% of total billed charges ,891.12,24,,,percent of total billed charges,24% of total billed charges ,891.12,2970.4,
THORACENTESIS W IMAGING GUIDANCE,4430101,CDM,361,RC,32555,HCPCS,Outpatient,,,3713,1856.5,,997.31,26.86,,,percent of total billed charges,26.86% of total billed charges,2784.75,75,,,percent of total billed charges,75% of total billed charges ,2784.75,75,,,percent of total billed charges,75% of total billed charges ,891.12,24,,,percent of total billed charges,24% of total billed charges ,2784.75,75,,,percent of total billed charges,75% of total billed charges ,2784.75,75,,,percent of total billed charges,75% of total billed charges ,2970.4,80,,,percent of total billed charges,80% of total billed charges ,900.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,1871.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,2784.75,75,,,percent of total billed charges,75% of total billed charges ,908.94,24.48,,,percent of total billed charges,24.48% of total billed charges ,997.31,26.86,,,percent of total billed charges,26.86% of total billed charges,891.12,24,,,percent of total billed charges,24% of total billed charges ,1158.46,31.2,,,percent of total billed charges,31.2% of total billed charges,2970.4,80,,,percent of total billed charges,80% of total billed charges,891.12,24,,,percent of total billed charges,24% of total billed charges ,891.12,24,,,percent of total billed charges,24% of total billed charges ,891.12,2970.4,
LUMBAR SPINE COMPLETE,4490000,CDM,320,RC,72110,HCPCS,Outpatient,,,545,272.5,,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,436,80,,,percent of total billed charges,80% of total billed charges ,132.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,274.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,133.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,170.04,31.2,,,percent of total billed charges,31.2% of total billed charges,436,80,,,percent of total billed charges,80% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,436,
FLUOROSCOPY UP TO ONE HOUR,4490002,CDM,320,RC,76000,HCPCS,Outpatient,,,317,158.5,,85.15,26.86,,,percent of total billed charges,26.86% of total billed charges,237.75,75,,,percent of total billed charges,75% of total billed charges ,237.75,75,,,percent of total billed charges,75% of total billed charges ,76.08,24,,,percent of total billed charges,24% of total billed charges ,237.75,75,,,percent of total billed charges,75% of total billed charges ,237.75,75,,,percent of total billed charges,75% of total billed charges ,253.6,80,,,percent of total billed charges,80% of total billed charges ,76.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,159.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,237.75,75,,,percent of total billed charges,75% of total billed charges ,77.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,85.15,26.86,,,percent of total billed charges,26.86% of total billed charges,76.08,24,,,percent of total billed charges,24% of total billed charges ,98.9,31.2,,,percent of total billed charges,31.2% of total billed charges,253.6,80,,,percent of total billed charges,80% of total billed charges,76.08,24,,,percent of total billed charges,24% of total billed charges ,76.08,24,,,percent of total billed charges,24% of total billed charges ,76.08,253.6,
FLUOROSCOPY MORE THAN ONE HOUR,4490003,CDM,320,RC,76000,HCPCS,Outpatient,,,185.5,92.75,,49.83,26.86,,,percent of total billed charges,26.86% of total billed charges,139.13,75,,,percent of total billed charges,75% of total billed charges ,139.13,75,,,percent of total billed charges,75% of total billed charges ,44.52,24,,,percent of total billed charges,24% of total billed charges ,139.13,75,,,percent of total billed charges,75% of total billed charges ,139.13,75,,,percent of total billed charges,75% of total billed charges ,148.4,80,,,percent of total billed charges,80% of total billed charges ,44.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,93.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,139.13,75,,,percent of total billed charges,75% of total billed charges ,45.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,49.83,26.86,,,percent of total billed charges,26.86% of total billed charges,44.52,24,,,percent of total billed charges,24% of total billed charges ,57.88,31.2,,,percent of total billed charges,31.2% of total billed charges,148.4,80,,,percent of total billed charges,80% of total billed charges,44.52,24,,,percent of total billed charges,24% of total billed charges ,44.52,24,,,percent of total billed charges,24% of total billed charges ,44.52,148.4,
FLUOROSCOPY GUIDANCE FOR NEEDLE PLACE,4490004,CDM,320,RC,77002,HCPCS,Outpatient,,,180.5,90.25,,48.48,26.86,,,percent of total billed charges,26.86% of total billed charges,135.38,75,,,percent of total billed charges,75% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,43.32,24,,,percent of total billed charges,24% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,144.4,80,,,percent of total billed charges,80% of total billed charges ,43.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,90.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,44.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,48.48,26.86,,,percent of total billed charges,26.86% of total billed charges,43.32,24,,,percent of total billed charges,24% of total billed charges ,56.32,31.2,,,percent of total billed charges,31.2% of total billed charges,144.4,80,,,percent of total billed charges,80% of total billed charges,43.32,24,,,percent of total billed charges,24% of total billed charges ,43.32,24,,,percent of total billed charges,24% of total billed charges ,43.32,144.4,
CERVICAL MYELOGRAPHY,4490005,CDM,320,RC,72240,HCPCS,Outpatient,,,244,122,,65.54,26.86,,,percent of total billed charges,26.86% of total billed charges,183,75,,,percent of total billed charges,75% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,58.56,24,,,percent of total billed charges,24% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,195.2,80,,,percent of total billed charges,80% of total billed charges ,59.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,122.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,59.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,65.54,26.86,,,percent of total billed charges,26.86% of total billed charges,58.56,24,,,percent of total billed charges,24% of total billed charges ,76.13,31.2,,,percent of total billed charges,31.2% of total billed charges,195.2,80,,,percent of total billed charges,80% of total billed charges,58.56,24,,,percent of total billed charges,24% of total billed charges ,58.56,24,,,percent of total billed charges,24% of total billed charges ,58.56,195.2,
THORACIC MYELOGRAPHY,4490006,CDM,320,RC,72255,HCPCS,Outpatient,,,414,207,,111.2,26.86,,,percent of total billed charges,26.86% of total billed charges,310.5,75,,,percent of total billed charges,75% of total billed charges ,310.5,75,,,percent of total billed charges,75% of total billed charges ,99.36,24,,,percent of total billed charges,24% of total billed charges ,310.5,75,,,percent of total billed charges,75% of total billed charges ,310.5,75,,,percent of total billed charges,75% of total billed charges ,331.2,80,,,percent of total billed charges,80% of total billed charges ,100.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,208.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,310.5,75,,,percent of total billed charges,75% of total billed charges ,101.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,111.2,26.86,,,percent of total billed charges,26.86% of total billed charges,99.36,24,,,percent of total billed charges,24% of total billed charges ,129.17,31.2,,,percent of total billed charges,31.2% of total billed charges,331.2,80,,,percent of total billed charges,80% of total billed charges,99.36,24,,,percent of total billed charges,24% of total billed charges ,99.36,24,,,percent of total billed charges,24% of total billed charges ,99.36,331.2,
LUMBARSACRAL MYELOGRAPHY,4490007,CDM,320,RC,72265,HCPCS,Outpatient,,,446,223,,119.8,26.86,,,percent of total billed charges,26.86% of total billed charges,334.5,75,,,percent of total billed charges,75% of total billed charges ,334.5,75,,,percent of total billed charges,75% of total billed charges ,107.04,24,,,percent of total billed charges,24% of total billed charges ,334.5,75,,,percent of total billed charges,75% of total billed charges ,334.5,75,,,percent of total billed charges,75% of total billed charges ,356.8,80,,,percent of total billed charges,80% of total billed charges ,108.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,224.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,334.5,75,,,percent of total billed charges,75% of total billed charges ,109.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,119.8,26.86,,,percent of total billed charges,26.86% of total billed charges,107.04,24,,,percent of total billed charges,24% of total billed charges ,139.15,31.2,,,percent of total billed charges,31.2% of total billed charges,356.8,80,,,percent of total billed charges,80% of total billed charges,107.04,24,,,percent of total billed charges,24% of total billed charges ,107.04,24,,,percent of total billed charges,24% of total billed charges ,107.04,356.8,
SHOULDER ARTHROGRAM LT,4490008,CDM,320,RC,73040,HCPCS,Outpatient,,,360.5,180.25,,96.83,26.86,,,percent of total billed charges,26.86% of total billed charges,270.38,75,,,percent of total billed charges,75% of total billed charges ,270.38,75,,,percent of total billed charges,75% of total billed charges ,86.52,24,,,percent of total billed charges,24% of total billed charges ,270.38,75,,,percent of total billed charges,75% of total billed charges ,270.38,75,,,percent of total billed charges,75% of total billed charges ,288.4,80,,,percent of total billed charges,80% of total billed charges ,87.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,181.69,50.4,,,percent of total billed charges,50.4% of total billed charges ,270.38,75,,,percent of total billed charges,75% of total billed charges ,88.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,96.83,26.86,,,percent of total billed charges,26.86% of total billed charges,86.52,24,,,percent of total billed charges,24% of total billed charges ,112.48,31.2,,,percent of total billed charges,31.2% of total billed charges,288.4,80,,,percent of total billed charges,80% of total billed charges,86.52,24,,,percent of total billed charges,24% of total billed charges ,86.52,24,,,percent of total billed charges,24% of total billed charges ,86.52,288.4,
ELBOW ARTHROGRAM LT,4490009,CDM,320,RC,73085,HCPCS,Outpatient,,,392.5,196.25,,105.43,26.86,,,percent of total billed charges,26.86% of total billed charges,294.38,75,,,percent of total billed charges,75% of total billed charges ,294.38,75,,,percent of total billed charges,75% of total billed charges ,94.2,24,,,percent of total billed charges,24% of total billed charges ,294.38,75,,,percent of total billed charges,75% of total billed charges ,294.38,75,,,percent of total billed charges,75% of total billed charges ,314,80,,,percent of total billed charges,80% of total billed charges ,95.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,197.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,294.38,75,,,percent of total billed charges,75% of total billed charges ,96.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,105.43,26.86,,,percent of total billed charges,26.86% of total billed charges,94.2,24,,,percent of total billed charges,24% of total billed charges ,122.46,31.2,,,percent of total billed charges,31.2% of total billed charges,314,80,,,percent of total billed charges,80% of total billed charges,94.2,24,,,percent of total billed charges,24% of total billed charges ,94.2,24,,,percent of total billed charges,24% of total billed charges ,94.2,314,
WRIST ARTHROGRAM LT,4490010,CDM,320,RC,73115,HCPCS,Outpatient,,,546,273,,146.66,26.86,,,percent of total billed charges,26.86% of total billed charges,409.5,75,,,percent of total billed charges,75% of total billed charges ,409.5,75,,,percent of total billed charges,75% of total billed charges ,131.04,24,,,percent of total billed charges,24% of total billed charges ,409.5,75,,,percent of total billed charges,75% of total billed charges ,409.5,75,,,percent of total billed charges,75% of total billed charges ,436.8,80,,,percent of total billed charges,80% of total billed charges ,132.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,275.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,409.5,75,,,percent of total billed charges,75% of total billed charges ,133.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,146.66,26.86,,,percent of total billed charges,26.86% of total billed charges,131.04,24,,,percent of total billed charges,24% of total billed charges ,170.35,31.2,,,percent of total billed charges,31.2% of total billed charges,436.8,80,,,percent of total billed charges,80% of total billed charges,131.04,24,,,percent of total billed charges,24% of total billed charges ,131.04,24,,,percent of total billed charges,24% of total billed charges ,131.04,436.8,
HIP ARTHROGRAM LT,4490011,CDM,320,RC,73525,HCPCS,Outpatient,,,615,307.5,,165.19,26.86,,,percent of total billed charges,26.86% of total billed charges,461.25,75,,,percent of total billed charges,75% of total billed charges ,461.25,75,,,percent of total billed charges,75% of total billed charges ,147.6,24,,,percent of total billed charges,24% of total billed charges ,461.25,75,,,percent of total billed charges,75% of total billed charges ,461.25,75,,,percent of total billed charges,75% of total billed charges ,492,80,,,percent of total billed charges,80% of total billed charges ,149.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,309.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,461.25,75,,,percent of total billed charges,75% of total billed charges ,150.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,165.19,26.86,,,percent of total billed charges,26.86% of total billed charges,147.6,24,,,percent of total billed charges,24% of total billed charges ,191.88,31.2,,,percent of total billed charges,31.2% of total billed charges,492,80,,,percent of total billed charges,80% of total billed charges,147.6,24,,,percent of total billed charges,24% of total billed charges ,147.6,24,,,percent of total billed charges,24% of total billed charges ,147.6,492,
KNEE ARTHROGRAM  LT,4490012,CDM,320,RC,73580,HCPCS,Outpatient,,,368.5,184.25,,98.98,26.86,,,percent of total billed charges,26.86% of total billed charges,276.38,75,,,percent of total billed charges,75% of total billed charges ,276.38,75,,,percent of total billed charges,75% of total billed charges ,88.44,24,,,percent of total billed charges,24% of total billed charges ,276.38,75,,,percent of total billed charges,75% of total billed charges ,276.38,75,,,percent of total billed charges,75% of total billed charges ,294.8,80,,,percent of total billed charges,80% of total billed charges ,89.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,185.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,276.38,75,,,percent of total billed charges,75% of total billed charges ,90.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,98.98,26.86,,,percent of total billed charges,26.86% of total billed charges,88.44,24,,,percent of total billed charges,24% of total billed charges ,114.97,31.2,,,percent of total billed charges,31.2% of total billed charges,294.8,80,,,percent of total billed charges,80% of total billed charges,88.44,24,,,percent of total billed charges,24% of total billed charges ,88.44,24,,,percent of total billed charges,24% of total billed charges ,88.44,294.8,
ANKLE ARTHROGRAM LT,4490013,CDM,320,RC,73615,HCPCS,Outpatient,,,397.5,198.75,,106.77,26.86,,,percent of total billed charges,26.86% of total billed charges,298.13,75,,,percent of total billed charges,75% of total billed charges ,298.13,75,,,percent of total billed charges,75% of total billed charges ,95.4,24,,,percent of total billed charges,24% of total billed charges ,298.13,75,,,percent of total billed charges,75% of total billed charges ,298.13,75,,,percent of total billed charges,75% of total billed charges ,318,80,,,percent of total billed charges,80% of total billed charges ,96.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,200.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,298.13,75,,,percent of total billed charges,75% of total billed charges ,97.31,24.48,,,percent of total billed charges,24.48% of total billed charges ,106.77,26.86,,,percent of total billed charges,26.86% of total billed charges,95.4,24,,,percent of total billed charges,24% of total billed charges ,124.02,31.2,,,percent of total billed charges,31.2% of total billed charges,318,80,,,percent of total billed charges,80% of total billed charges,95.4,24,,,percent of total billed charges,24% of total billed charges ,95.4,24,,,percent of total billed charges,24% of total billed charges ,95.4,318,
SHOULDER ARTHROGRAM RT,4490014,CDM,320,RC,73040,HCPCS,Outpatient,,,360.5,180.25,,96.83,26.86,,,percent of total billed charges,26.86% of total billed charges,270.38,75,,,percent of total billed charges,75% of total billed charges ,270.38,75,,,percent of total billed charges,75% of total billed charges ,86.52,24,,,percent of total billed charges,24% of total billed charges ,270.38,75,,,percent of total billed charges,75% of total billed charges ,270.38,75,,,percent of total billed charges,75% of total billed charges ,288.4,80,,,percent of total billed charges,80% of total billed charges ,87.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,181.69,50.4,,,percent of total billed charges,50.4% of total billed charges ,270.38,75,,,percent of total billed charges,75% of total billed charges ,88.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,96.83,26.86,,,percent of total billed charges,26.86% of total billed charges,86.52,24,,,percent of total billed charges,24% of total billed charges ,112.48,31.2,,,percent of total billed charges,31.2% of total billed charges,288.4,80,,,percent of total billed charges,80% of total billed charges,86.52,24,,,percent of total billed charges,24% of total billed charges ,86.52,24,,,percent of total billed charges,24% of total billed charges ,86.52,288.4,
ELBOW ARTHROGRAM RT,4490015,CDM,320,RC,73085,HCPCS,Outpatient,,,392.5,196.25,,105.43,26.86,,,percent of total billed charges,26.86% of total billed charges,294.38,75,,,percent of total billed charges,75% of total billed charges ,294.38,75,,,percent of total billed charges,75% of total billed charges ,94.2,24,,,percent of total billed charges,24% of total billed charges ,294.38,75,,,percent of total billed charges,75% of total billed charges ,294.38,75,,,percent of total billed charges,75% of total billed charges ,314,80,,,percent of total billed charges,80% of total billed charges ,95.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,197.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,294.38,75,,,percent of total billed charges,75% of total billed charges ,96.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,105.43,26.86,,,percent of total billed charges,26.86% of total billed charges,94.2,24,,,percent of total billed charges,24% of total billed charges ,122.46,31.2,,,percent of total billed charges,31.2% of total billed charges,314,80,,,percent of total billed charges,80% of total billed charges,94.2,24,,,percent of total billed charges,24% of total billed charges ,94.2,24,,,percent of total billed charges,24% of total billed charges ,94.2,314,
WRIST ARTHROGRAM RT,4490016,CDM,320,RC,73115,HCPCS,Outpatient,,,546,273,,146.66,26.86,,,percent of total billed charges,26.86% of total billed charges,409.5,75,,,percent of total billed charges,75% of total billed charges ,409.5,75,,,percent of total billed charges,75% of total billed charges ,131.04,24,,,percent of total billed charges,24% of total billed charges ,409.5,75,,,percent of total billed charges,75% of total billed charges ,409.5,75,,,percent of total billed charges,75% of total billed charges ,436.8,80,,,percent of total billed charges,80% of total billed charges ,132.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,275.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,409.5,75,,,percent of total billed charges,75% of total billed charges ,133.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,146.66,26.86,,,percent of total billed charges,26.86% of total billed charges,131.04,24,,,percent of total billed charges,24% of total billed charges ,170.35,31.2,,,percent of total billed charges,31.2% of total billed charges,436.8,80,,,percent of total billed charges,80% of total billed charges,131.04,24,,,percent of total billed charges,24% of total billed charges ,131.04,24,,,percent of total billed charges,24% of total billed charges ,131.04,436.8,
HIP ARTHROGRAM RT,4490017,CDM,320,RC,73525,HCPCS,Outpatient,,,615,307.5,,165.19,26.86,,,percent of total billed charges,26.86% of total billed charges,461.25,75,,,percent of total billed charges,75% of total billed charges ,461.25,75,,,percent of total billed charges,75% of total billed charges ,147.6,24,,,percent of total billed charges,24% of total billed charges ,461.25,75,,,percent of total billed charges,75% of total billed charges ,461.25,75,,,percent of total billed charges,75% of total billed charges ,492,80,,,percent of total billed charges,80% of total billed charges ,149.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,309.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,461.25,75,,,percent of total billed charges,75% of total billed charges ,150.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,165.19,26.86,,,percent of total billed charges,26.86% of total billed charges,147.6,24,,,percent of total billed charges,24% of total billed charges ,191.88,31.2,,,percent of total billed charges,31.2% of total billed charges,492,80,,,percent of total billed charges,80% of total billed charges,147.6,24,,,percent of total billed charges,24% of total billed charges ,147.6,24,,,percent of total billed charges,24% of total billed charges ,147.6,492,
KNEE ARTHROGRAM  RT,4490018,CDM,320,RC,73580,HCPCS,Outpatient,,,368.5,184.25,,98.98,26.86,,,percent of total billed charges,26.86% of total billed charges,276.38,75,,,percent of total billed charges,75% of total billed charges ,276.38,75,,,percent of total billed charges,75% of total billed charges ,88.44,24,,,percent of total billed charges,24% of total billed charges ,276.38,75,,,percent of total billed charges,75% of total billed charges ,276.38,75,,,percent of total billed charges,75% of total billed charges ,294.8,80,,,percent of total billed charges,80% of total billed charges ,89.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,185.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,276.38,75,,,percent of total billed charges,75% of total billed charges ,90.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,98.98,26.86,,,percent of total billed charges,26.86% of total billed charges,88.44,24,,,percent of total billed charges,24% of total billed charges ,114.97,31.2,,,percent of total billed charges,31.2% of total billed charges,294.8,80,,,percent of total billed charges,80% of total billed charges,88.44,24,,,percent of total billed charges,24% of total billed charges ,88.44,24,,,percent of total billed charges,24% of total billed charges ,88.44,294.8,
ANKLE ARTHROGRAM RT,4490019,CDM,320,RC,73615,HCPCS,Outpatient,,,397.5,198.75,,106.77,26.86,,,percent of total billed charges,26.86% of total billed charges,298.13,75,,,percent of total billed charges,75% of total billed charges ,298.13,75,,,percent of total billed charges,75% of total billed charges ,95.4,24,,,percent of total billed charges,24% of total billed charges ,298.13,75,,,percent of total billed charges,75% of total billed charges ,298.13,75,,,percent of total billed charges,75% of total billed charges ,318,80,,,percent of total billed charges,80% of total billed charges ,96.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,200.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,298.13,75,,,percent of total billed charges,75% of total billed charges ,97.31,24.48,,,percent of total billed charges,24.48% of total billed charges ,106.77,26.86,,,percent of total billed charges,26.86% of total billed charges,95.4,24,,,percent of total billed charges,24% of total billed charges ,124.02,31.2,,,percent of total billed charges,31.2% of total billed charges,318,80,,,percent of total billed charges,80% of total billed charges,95.4,24,,,percent of total billed charges,24% of total billed charges ,95.4,24,,,percent of total billed charges,24% of total billed charges ,95.4,318,
US ARTERIAL EXT/ABI UNI LT,4520062,CDM,921,RC,93922,HCPCS,Outpatient,,,545,272.5,,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,436,80,,,percent of total billed charges,80% of total billed charges ,132.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,274.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,133.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,170.04,31.2,,,percent of total billed charges,31.2% of total billed charges,436,80,,,percent of total billed charges,80% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,436,
US EXT VENOUS DOPPLER RT,4520063,CDM,921,RC,93971,HCPCS,Outpatient,,,545,272.5,,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,436,80,,,percent of total billed charges,80% of total billed charges ,132.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,274.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,133.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,170.04,31.2,,,percent of total billed charges,31.2% of total billed charges,436,80,,,percent of total billed charges,80% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,436,
US EXT VENOUS DOPPLER LT,4520064,CDM,921,RC,93971,HCPCS,Outpatient,,,545,272.5,,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,436,80,,,percent of total billed charges,80% of total billed charges ,132.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,274.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,133.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,170.04,31.2,,,percent of total billed charges,31.2% of total billed charges,436,80,,,percent of total billed charges,80% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,436,
US RENAL ARTERY DOPPLER,4520065,CDM,921,RC,93975,HCPCS,Outpatient,,,384,192,,103.14,26.86,,,percent of total billed charges,26.86% of total billed charges,288,75,,,percent of total billed charges,75% of total billed charges ,288,75,,,percent of total billed charges,75% of total billed charges ,92.16,24,,,percent of total billed charges,24% of total billed charges ,288,75,,,percent of total billed charges,75% of total billed charges ,288,75,,,percent of total billed charges,75% of total billed charges ,307.2,80,,,percent of total billed charges,80% of total billed charges ,93.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,193.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,288,75,,,percent of total billed charges,75% of total billed charges ,94,24.48,,,percent of total billed charges,24.48% of total billed charges ,103.14,26.86,,,percent of total billed charges,26.86% of total billed charges,92.16,24,,,percent of total billed charges,24% of total billed charges ,119.81,31.2,,,percent of total billed charges,31.2% of total billed charges,307.2,80,,,percent of total billed charges,80% of total billed charges,92.16,24,,,percent of total billed charges,24% of total billed charges ,92.16,24,,,percent of total billed charges,24% of total billed charges ,92.16,307.2,
US THYROID/NECK,4560004,CDM,402,RC,76536,HCPCS,Outpatient,,,682,341,,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,545.6,80,,,percent of total billed charges,80% of total billed charges ,165.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,343.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,166.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,212.78,31.2,,,percent of total billed charges,31.2% of total billed charges,545.6,80,,,percent of total billed charges,80% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,545.6,
US EXT ARTERY RT DOPPLER,4560005,CDM,921,RC,93923,HCPCS,Outpatient,,,545,272.5,,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,436,80,,,percent of total billed charges,80% of total billed charges ,132.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,274.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,133.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,170.04,31.2,,,percent of total billed charges,31.2% of total billed charges,436,80,,,percent of total billed charges,80% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,436,
US EXT ARTERY LT DOPPLER,4560006,CDM,921,RC,93923,HCPCS,Outpatient,,,545,272.5,,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,436,80,,,percent of total billed charges,80% of total billed charges ,132.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,274.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,133.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,170.04,31.2,,,percent of total billed charges,31.2% of total billed charges,436,80,,,percent of total billed charges,80% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,436,
US EXT RT,4560007,CDM,402,RC,76882,HCPCS,Outpatient,,,525.5,262.75,,141.15,26.86,,,percent of total billed charges,26.86% of total billed charges,394.13,75,,,percent of total billed charges,75% of total billed charges ,394.13,75,,,percent of total billed charges,75% of total billed charges ,126.12,24,,,percent of total billed charges,24% of total billed charges ,394.13,75,,,percent of total billed charges,75% of total billed charges ,394.13,75,,,percent of total billed charges,75% of total billed charges ,420.4,80,,,percent of total billed charges,80% of total billed charges ,127.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,264.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,394.13,75,,,percent of total billed charges,75% of total billed charges ,128.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,141.15,26.86,,,percent of total billed charges,26.86% of total billed charges,126.12,24,,,percent of total billed charges,24% of total billed charges ,163.96,31.2,,,percent of total billed charges,31.2% of total billed charges,420.4,80,,,percent of total billed charges,80% of total billed charges,126.12,24,,,percent of total billed charges,24% of total billed charges ,126.12,24,,,percent of total billed charges,24% of total billed charges ,126.12,420.4,
US ABDOMEN COMPLETE,4560008,CDM,402,RC,76700,HCPCS,Outpatient,,,682,341,,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,545.6,80,,,percent of total billed charges,80% of total billed charges ,165.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,343.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,166.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,212.78,31.2,,,percent of total billed charges,31.2% of total billed charges,545.6,80,,,percent of total billed charges,80% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,545.6,
US LIVER,4560009,CDM,402,RC,76705,HCPCS,Outpatient,,,682,341,,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,545.6,80,,,percent of total billed charges,80% of total billed charges ,165.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,343.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,166.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,212.78,31.2,,,percent of total billed charges,31.2% of total billed charges,545.6,80,,,percent of total billed charges,80% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,545.6,
US GALLBLADDER,4560010,CDM,402,RC,76705,HCPCS,Outpatient,,,593.5,296.75,,159.41,26.86,,,percent of total billed charges,26.86% of total billed charges,445.13,75,,,percent of total billed charges,75% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,142.44,24,,,percent of total billed charges,24% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,474.8,80,,,percent of total billed charges,80% of total billed charges ,143.86,24.24,,,percent of total billed charges,24.24% of total billed charges ,299.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,145.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,159.41,26.86,,,percent of total billed charges,26.86% of total billed charges,142.44,24,,,percent of total billed charges,24% of total billed charges ,185.17,31.2,,,percent of total billed charges,31.2% of total billed charges,474.8,80,,,percent of total billed charges,80% of total billed charges,142.44,24,,,percent of total billed charges,24% of total billed charges ,142.44,24,,,percent of total billed charges,24% of total billed charges ,142.44,474.8,
US RENAL,4560011,CDM,402,RC,76770,HCPCS,Outpatient,,,682,341,,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,545.6,80,,,percent of total billed charges,80% of total billed charges ,165.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,343.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,166.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,212.78,31.2,,,percent of total billed charges,31.2% of total billed charges,545.6,80,,,percent of total billed charges,80% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,545.6,
US PANCREAS,4560012,CDM,402,RC,76705,HCPCS,Outpatient,,,2652.5,1326.25,,712.46,26.86,,,percent of total billed charges,26.86% of total billed charges,1989.38,75,,,percent of total billed charges,75% of total billed charges ,1989.38,75,,,percent of total billed charges,75% of total billed charges ,636.6,24,,,percent of total billed charges,24% of total billed charges ,1989.38,75,,,percent of total billed charges,75% of total billed charges ,1989.38,75,,,percent of total billed charges,75% of total billed charges ,2122,80,,,percent of total billed charges,80% of total billed charges ,642.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,1336.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,1989.38,75,,,percent of total billed charges,75% of total billed charges ,649.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,712.46,26.86,,,percent of total billed charges,26.86% of total billed charges,636.6,24,,,percent of total billed charges,24% of total billed charges ,827.58,31.2,,,percent of total billed charges,31.2% of total billed charges,2122,80,,,percent of total billed charges,80% of total billed charges,636.6,24,,,percent of total billed charges,24% of total billed charges ,636.6,24,,,percent of total billed charges,24% of total billed charges ,636.6,2122,
US SPLEEN,4560013,CDM,402,RC,76705,HCPCS,Outpatient,,,593.5,296.75,,159.41,26.86,,,percent of total billed charges,26.86% of total billed charges,445.13,75,,,percent of total billed charges,75% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,142.44,24,,,percent of total billed charges,24% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,474.8,80,,,percent of total billed charges,80% of total billed charges ,143.86,24.24,,,percent of total billed charges,24.24% of total billed charges ,299.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,145.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,159.41,26.86,,,percent of total billed charges,26.86% of total billed charges,142.44,24,,,percent of total billed charges,24% of total billed charges ,185.17,31.2,,,percent of total billed charges,31.2% of total billed charges,474.8,80,,,percent of total billed charges,80% of total billed charges,142.44,24,,,percent of total billed charges,24% of total billed charges ,142.44,24,,,percent of total billed charges,24% of total billed charges ,142.44,474.8,
US AORTA,4560014,CDM,402,RC,76770,HCPCS,Outpatient,,,593.5,296.75,,159.41,26.86,,,percent of total billed charges,26.86% of total billed charges,445.13,75,,,percent of total billed charges,75% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,142.44,24,,,percent of total billed charges,24% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,474.8,80,,,percent of total billed charges,80% of total billed charges ,143.86,24.24,,,percent of total billed charges,24.24% of total billed charges ,299.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,145.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,159.41,26.86,,,percent of total billed charges,26.86% of total billed charges,142.44,24,,,percent of total billed charges,24% of total billed charges ,185.17,31.2,,,percent of total billed charges,31.2% of total billed charges,474.8,80,,,percent of total billed charges,80% of total billed charges,142.44,24,,,percent of total billed charges,24% of total billed charges ,142.44,24,,,percent of total billed charges,24% of total billed charges ,142.44,474.8,
US URINARY BLADDER,4560016,CDM,402,RC,76856,HCPCS,Outpatient,,,593.5,296.75,,159.41,26.86,,,percent of total billed charges,26.86% of total billed charges,445.13,75,,,percent of total billed charges,75% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,142.44,24,,,percent of total billed charges,24% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,474.8,80,,,percent of total billed charges,80% of total billed charges ,143.86,24.24,,,percent of total billed charges,24.24% of total billed charges ,299.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,145.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,159.41,26.86,,,percent of total billed charges,26.86% of total billed charges,142.44,24,,,percent of total billed charges,24% of total billed charges ,185.17,31.2,,,percent of total billed charges,31.2% of total billed charges,474.8,80,,,percent of total billed charges,80% of total billed charges,142.44,24,,,percent of total billed charges,24% of total billed charges ,142.44,24,,,percent of total billed charges,24% of total billed charges ,142.44,474.8,
US EXT RT,4560017,CDM,402,RC,76882,HCPCS,Outpatient,,,525.5,262.75,,141.15,26.86,,,percent of total billed charges,26.86% of total billed charges,394.13,75,,,percent of total billed charges,75% of total billed charges ,394.13,75,,,percent of total billed charges,75% of total billed charges ,126.12,24,,,percent of total billed charges,24% of total billed charges ,394.13,75,,,percent of total billed charges,75% of total billed charges ,394.13,75,,,percent of total billed charges,75% of total billed charges ,420.4,80,,,percent of total billed charges,80% of total billed charges ,127.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,264.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,394.13,75,,,percent of total billed charges,75% of total billed charges ,128.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,141.15,26.86,,,percent of total billed charges,26.86% of total billed charges,126.12,24,,,percent of total billed charges,24% of total billed charges ,163.96,31.2,,,percent of total billed charges,31.2% of total billed charges,420.4,80,,,percent of total billed charges,80% of total billed charges,126.12,24,,,percent of total billed charges,24% of total billed charges ,126.12,24,,,percent of total billed charges,24% of total billed charges ,126.12,420.4,
US VEIN RT,4560018,CDM,921,RC,93970,HCPCS,Outpatient,,,474,237,,127.32,26.86,,,percent of total billed charges,26.86% of total billed charges,355.5,75,,,percent of total billed charges,75% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,379.2,80,,,percent of total billed charges,80% of total billed charges ,114.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,238.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,116.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,127.32,26.86,,,percent of total billed charges,26.86% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,147.89,31.2,,,percent of total billed charges,31.2% of total billed charges,379.2,80,,,percent of total billed charges,80% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,379.2,
US VEIN LT,4560019,CDM,921,RC,93970,HCPCS,Outpatient,,,474,237,,127.32,26.86,,,percent of total billed charges,26.86% of total billed charges,355.5,75,,,percent of total billed charges,75% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,379.2,80,,,percent of total billed charges,80% of total billed charges ,114.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,238.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,116.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,127.32,26.86,,,percent of total billed charges,26.86% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,147.89,31.2,,,percent of total billed charges,31.2% of total billed charges,379.2,80,,,percent of total billed charges,80% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,379.2,
OB TRANSABDOMINAL 1ST TRIMESTER,4560020,CDM,402,RC,76801,HCPCS,Outpatient,,,445,222.5,,119.53,26.86,,,percent of total billed charges,26.86% of total billed charges,333.75,75,,,percent of total billed charges,75% of total billed charges ,333.75,75,,,percent of total billed charges,75% of total billed charges ,106.8,24,,,percent of total billed charges,24% of total billed charges ,333.75,75,,,percent of total billed charges,75% of total billed charges ,333.75,75,,,percent of total billed charges,75% of total billed charges ,356,80,,,percent of total billed charges,80% of total billed charges ,107.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,224.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,333.75,75,,,percent of total billed charges,75% of total billed charges ,108.94,24.48,,,percent of total billed charges,24.48% of total billed charges ,119.53,26.86,,,percent of total billed charges,26.86% of total billed charges,106.8,24,,,percent of total billed charges,24% of total billed charges ,138.84,31.2,,,percent of total billed charges,31.2% of total billed charges,356,80,,,percent of total billed charges,80% of total billed charges,106.8,24,,,percent of total billed charges,24% of total billed charges ,106.8,24,,,percent of total billed charges,24% of total billed charges ,106.8,356,
US OB TRANSVAGINAL,4560021,CDM,402,RC,76817,HCPCS,Outpatient,,,560.5,280.25,,150.55,26.86,,,percent of total billed charges,26.86% of total billed charges,420.38,75,,,percent of total billed charges,75% of total billed charges ,420.38,75,,,percent of total billed charges,75% of total billed charges ,134.52,24,,,percent of total billed charges,24% of total billed charges ,420.38,75,,,percent of total billed charges,75% of total billed charges ,420.38,75,,,percent of total billed charges,75% of total billed charges ,448.4,80,,,percent of total billed charges,80% of total billed charges ,135.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,282.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,420.38,75,,,percent of total billed charges,75% of total billed charges ,137.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,150.55,26.86,,,percent of total billed charges,26.86% of total billed charges,134.52,24,,,percent of total billed charges,24% of total billed charges ,174.88,31.2,,,percent of total billed charges,31.2% of total billed charges,448.4,80,,,percent of total billed charges,80% of total billed charges,134.52,24,,,percent of total billed charges,24% of total billed charges ,134.52,24,,,percent of total billed charges,24% of total billed charges ,134.52,448.4,
US OB LIMITED,4560022,CDM,402,RC,76815,HCPCS,Outpatient,,,433.5,216.75,,116.44,26.86,,,percent of total billed charges,26.86% of total billed charges,325.13,75,,,percent of total billed charges,75% of total billed charges ,325.13,75,,,percent of total billed charges,75% of total billed charges ,104.04,24,,,percent of total billed charges,24% of total billed charges ,325.13,75,,,percent of total billed charges,75% of total billed charges ,325.13,75,,,percent of total billed charges,75% of total billed charges ,346.8,80,,,percent of total billed charges,80% of total billed charges ,105.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,218.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,325.13,75,,,percent of total billed charges,75% of total billed charges ,106.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,116.44,26.86,,,percent of total billed charges,26.86% of total billed charges,104.04,24,,,percent of total billed charges,24% of total billed charges ,135.25,31.2,,,percent of total billed charges,31.2% of total billed charges,346.8,80,,,percent of total billed charges,80% of total billed charges,104.04,24,,,percent of total billed charges,24% of total billed charges ,104.04,24,,,percent of total billed charges,24% of total billed charges ,104.04,346.8,
US OB <14 WEEKS,4560023,CDM,402,RC,76801,HCPCS,Outpatient,,,445,222.5,,119.53,26.86,,,percent of total billed charges,26.86% of total billed charges,333.75,75,,,percent of total billed charges,75% of total billed charges ,333.75,75,,,percent of total billed charges,75% of total billed charges ,106.8,24,,,percent of total billed charges,24% of total billed charges ,333.75,75,,,percent of total billed charges,75% of total billed charges ,333.75,75,,,percent of total billed charges,75% of total billed charges ,356,80,,,percent of total billed charges,80% of total billed charges ,107.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,224.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,333.75,75,,,percent of total billed charges,75% of total billed charges ,108.94,24.48,,,percent of total billed charges,24.48% of total billed charges ,119.53,26.86,,,percent of total billed charges,26.86% of total billed charges,106.8,24,,,percent of total billed charges,24% of total billed charges ,138.84,31.2,,,percent of total billed charges,31.2% of total billed charges,356,80,,,percent of total billed charges,80% of total billed charges,106.8,24,,,percent of total billed charges,24% of total billed charges ,106.8,24,,,percent of total billed charges,24% of total billed charges ,106.8,356,
US ABDOMINAL DOPPLER,4560024,CDM,921,RC,93975,HCPCS,Outpatient,,,444,222,,119.26,26.86,,,percent of total billed charges,26.86% of total billed charges,333,75,,,percent of total billed charges,75% of total billed charges ,333,75,,,percent of total billed charges,75% of total billed charges ,106.56,24,,,percent of total billed charges,24% of total billed charges ,333,75,,,percent of total billed charges,75% of total billed charges ,333,75,,,percent of total billed charges,75% of total billed charges ,355.2,80,,,percent of total billed charges,80% of total billed charges ,107.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,223.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,333,75,,,percent of total billed charges,75% of total billed charges ,108.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,119.26,26.86,,,percent of total billed charges,26.86% of total billed charges,106.56,24,,,percent of total billed charges,24% of total billed charges ,138.53,31.2,,,percent of total billed charges,31.2% of total billed charges,355.2,80,,,percent of total billed charges,80% of total billed charges,106.56,24,,,percent of total billed charges,24% of total billed charges ,106.56,24,,,percent of total billed charges,24% of total billed charges ,106.56,355.2,
US PELVIC NON OB,4560025,CDM,402,RC,76856,HCPCS,Outpatient,,,682,341,,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,545.6,80,,,percent of total billed charges,80% of total billed charges ,165.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,343.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,166.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,212.78,31.2,,,percent of total billed charges,31.2% of total billed charges,545.6,80,,,percent of total billed charges,80% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,545.6,
US GUIDE FOR BIOPSY,4560026,CDM,402,RC,76942,HCPCS,Outpatient,,,682,341,,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,545.6,80,,,percent of total billed charges,80% of total billed charges ,165.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,343.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,166.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,212.78,31.2,,,percent of total billed charges,31.2% of total billed charges,545.6,80,,,percent of total billed charges,80% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,545.6,
US SCROTUM AND CONTENTS,4560028,CDM,402,RC,76870,HCPCS,Outpatient,,,682,341,,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,545.6,80,,,percent of total billed charges,80% of total billed charges ,165.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,343.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,166.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,212.78,31.2,,,percent of total billed charges,31.2% of total billed charges,545.6,80,,,percent of total billed charges,80% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,545.6,
US PENILE DOPPLER,4560029,CDM,402,RC,93980,HCPCS,Outpatient,,,682,341,,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,545.6,80,,,percent of total billed charges,80% of total billed charges ,165.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,343.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,166.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,212.78,31.2,,,percent of total billed charges,31.2% of total billed charges,545.6,80,,,percent of total billed charges,80% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,545.6,
US TRANSVAGINAL,4560033,CDM,402,RC,76830,HCPCS,Outpatient,,,750,375,,201.45,26.86,,,percent of total billed charges,26.86% of total billed charges,562.5,75,,,percent of total billed charges,75% of total billed charges ,562.5,75,,,percent of total billed charges,75% of total billed charges ,180,24,,,percent of total billed charges,24% of total billed charges ,562.5,75,,,percent of total billed charges,75% of total billed charges ,562.5,75,,,percent of total billed charges,75% of total billed charges ,600,80,,,percent of total billed charges,80% of total billed charges ,181.8,24.24,,,percent of total billed charges,24.24% of total billed charges ,378,50.4,,,percent of total billed charges,50.4% of total billed charges ,562.5,75,,,percent of total billed charges,75% of total billed charges ,183.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,201.45,26.86,,,percent of total billed charges,26.86% of total billed charges,180,24,,,percent of total billed charges,24% of total billed charges ,234,31.2,,,percent of total billed charges,31.2% of total billed charges,600,80,,,percent of total billed charges,80% of total billed charges,180,24,,,percent of total billed charges,24% of total billed charges ,180,24,,,percent of total billed charges,24% of total billed charges ,180,600,
US GUIDANCE DURING SURGERY,4560035,CDM,402,RC,76998,HCPCS,Outpatient,,,474,237,,127.32,26.86,,,percent of total billed charges,26.86% of total billed charges,355.5,75,,,percent of total billed charges,75% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,379.2,80,,,percent of total billed charges,80% of total billed charges ,114.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,238.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,116.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,127.32,26.86,,,percent of total billed charges,26.86% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,147.89,31.2,,,percent of total billed charges,31.2% of total billed charges,379.2,80,,,percent of total billed charges,80% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,379.2,
US VASCULAR ACCESS,4560036,CDM,402,RC,76937,HCPCS,Outpatient,,,274,137,,73.6,26.86,,,percent of total billed charges,26.86% of total billed charges,205.5,75,,,percent of total billed charges,75% of total billed charges ,205.5,75,,,percent of total billed charges,75% of total billed charges ,65.76,24,,,percent of total billed charges,24% of total billed charges ,205.5,75,,,percent of total billed charges,75% of total billed charges ,205.5,75,,,percent of total billed charges,75% of total billed charges ,219.2,80,,,percent of total billed charges,80% of total billed charges ,66.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,138.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,205.5,75,,,percent of total billed charges,75% of total billed charges ,67.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.6,26.86,,,percent of total billed charges,26.86% of total billed charges,65.76,24,,,percent of total billed charges,24% of total billed charges ,85.49,31.2,,,percent of total billed charges,31.2% of total billed charges,219.2,80,,,percent of total billed charges,80% of total billed charges,65.76,24,,,percent of total billed charges,24% of total billed charges ,65.76,24,,,percent of total billed charges,24% of total billed charges ,65.76,219.2,
US ABDOMEN LIMITED,4560039,CDM,402,RC,76705,HCPCS,Outpatient,,,682,341,,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,545.6,80,,,percent of total billed charges,80% of total billed charges ,165.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,343.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,166.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,212.78,31.2,,,percent of total billed charges,31.2% of total billed charges,545.6,80,,,percent of total billed charges,80% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,545.6,
ULTRASOUND GUIDANCE NEEDLE PLACEMENT,4560040,CDM,402,RC,76942,HCPCS,Outpatient,,,308,154,,82.73,26.86,,,percent of total billed charges,26.86% of total billed charges,231,75,,,percent of total billed charges,75% of total billed charges ,231,75,,,percent of total billed charges,75% of total billed charges ,73.92,24,,,percent of total billed charges,24% of total billed charges ,231,75,,,percent of total billed charges,75% of total billed charges ,231,75,,,percent of total billed charges,75% of total billed charges ,246.4,80,,,percent of total billed charges,80% of total billed charges ,74.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,155.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,231,75,,,percent of total billed charges,75% of total billed charges ,75.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,82.73,26.86,,,percent of total billed charges,26.86% of total billed charges,73.92,24,,,percent of total billed charges,24% of total billed charges ,96.1,31.2,,,percent of total billed charges,31.2% of total billed charges,246.4,80,,,percent of total billed charges,80% of total billed charges,73.92,24,,,percent of total billed charges,24% of total billed charges ,73.92,24,,,percent of total billed charges,24% of total billed charges ,73.92,246.4,
ULTRASOUND GUIDANCE NEEDLE WIRE IN BREAS,4560041,CDM,360,RC,19081,HCPCS,Outpatient,,,593.5,296.75,,159.41,26.86,,,percent of total billed charges,26.86% of total billed charges,445.13,75,,,percent of total billed charges,75% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,142.44,24,,,percent of total billed charges,24% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,474.8,80,,,percent of total billed charges,80% of total billed charges ,143.86,24.24,,,percent of total billed charges,24.24% of total billed charges ,299.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,145.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,159.41,26.86,,,percent of total billed charges,26.86% of total billed charges,142.44,24,,,percent of total billed charges,24% of total billed charges ,185.17,31.2,,,percent of total billed charges,31.2% of total billed charges,474.8,80,,,percent of total billed charges,80% of total billed charges,142.44,24,,,percent of total billed charges,24% of total billed charges ,142.44,24,,,percent of total billed charges,24% of total billed charges ,142.44,474.8,
SENTINEL NODE INJECTION,4560043,CDM,360,RC,38792,HCPCS,Outpatient,,,212,106,,56.94,26.86,,,percent of total billed charges,26.86% of total billed charges,159,75,,,percent of total billed charges,75% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,50.88,24,,,percent of total billed charges,24% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,169.6,80,,,percent of total billed charges,80% of total billed charges ,51.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,106.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,51.9,24.48,,,percent of total billed charges,24.48% of total billed charges ,56.94,26.86,,,percent of total billed charges,26.86% of total billed charges,50.88,24,,,percent of total billed charges,24% of total billed charges ,66.14,31.2,,,percent of total billed charges,31.2% of total billed charges,169.6,80,,,percent of total billed charges,80% of total billed charges,50.88,24,,,percent of total billed charges,24% of total billed charges ,50.88,24,,,percent of total billed charges,24% of total billed charges ,50.88,169.6,
US BREAST BIOPSY,4560044,CDM,360,RC,19083,HCPCS,Outpatient,,,3395,1697.5,,911.9,26.86,,,percent of total billed charges,26.86% of total billed charges,2546.25,75,,,percent of total billed charges,75% of total billed charges ,2546.25,75,,,percent of total billed charges,75% of total billed charges ,814.8,24,,,percent of total billed charges,24% of total billed charges ,2546.25,75,,,percent of total billed charges,75% of total billed charges ,2546.25,75,,,percent of total billed charges,75% of total billed charges ,2716,80,,,percent of total billed charges,80% of total billed charges ,822.95,24.24,,,percent of total billed charges,24.24% of total billed charges ,1711.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,2546.25,75,,,percent of total billed charges,75% of total billed charges ,831.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,911.9,26.86,,,percent of total billed charges,26.86% of total billed charges,814.8,24,,,percent of total billed charges,24% of total billed charges ,1059.24,31.2,,,percent of total billed charges,31.2% of total billed charges,2716,80,,,percent of total billed charges,80% of total billed charges,814.8,24,,,percent of total billed charges,24% of total billed charges ,814.8,24,,,percent of total billed charges,24% of total billed charges ,814.8,2716,
US AORTA/AAA,4560050,CDM,402,RC,76775,HCPCS,Outpatient,,,742.5,371.25,,199.44,26.86,,,percent of total billed charges,26.86% of total billed charges,556.88,75,,,percent of total billed charges,75% of total billed charges ,556.88,75,,,percent of total billed charges,75% of total billed charges ,178.2,24,,,percent of total billed charges,24% of total billed charges ,556.88,75,,,percent of total billed charges,75% of total billed charges ,556.88,75,,,percent of total billed charges,75% of total billed charges ,594,80,,,percent of total billed charges,80% of total billed charges ,179.98,24.24,,,percent of total billed charges,24.24% of total billed charges ,374.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,556.88,75,,,percent of total billed charges,75% of total billed charges ,181.76,24.48,,,percent of total billed charges,24.48% of total billed charges ,199.44,26.86,,,percent of total billed charges,26.86% of total billed charges,178.2,24,,,percent of total billed charges,24% of total billed charges ,231.66,31.2,,,percent of total billed charges,31.2% of total billed charges,594,80,,,percent of total billed charges,80% of total billed charges,178.2,24,,,percent of total billed charges,24% of total billed charges ,178.2,24,,,percent of total billed charges,24% of total billed charges ,178.2,594,
US ABI BILATERAL,4560060,CDM,921,RC,93922,HCPCS,Outpatient,,,703.5,351.75,,188.96,26.86,,,percent of total billed charges,26.86% of total billed charges,527.63,75,,,percent of total billed charges,75% of total billed charges ,527.63,75,,,percent of total billed charges,75% of total billed charges ,168.84,24,,,percent of total billed charges,24% of total billed charges ,527.63,75,,,percent of total billed charges,75% of total billed charges ,527.63,75,,,percent of total billed charges,75% of total billed charges ,562.8,80,,,percent of total billed charges,80% of total billed charges ,170.53,24.24,,,percent of total billed charges,24.24% of total billed charges ,354.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,527.63,75,,,percent of total billed charges,75% of total billed charges ,172.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,188.96,26.86,,,percent of total billed charges,26.86% of total billed charges,168.84,24,,,percent of total billed charges,24% of total billed charges ,219.49,31.2,,,percent of total billed charges,31.2% of total billed charges,562.8,80,,,percent of total billed charges,80% of total billed charges,168.84,24,,,percent of total billed charges,24% of total billed charges ,168.84,24,,,percent of total billed charges,24% of total billed charges ,168.84,562.8,
US BREAST BIL,4561200,CDM,402,RC,76642,HCPCS,Outpatient,,,265.5,132.75,,71.31,26.86,,,percent of total billed charges,26.86% of total billed charges,199.13,75,,,percent of total billed charges,75% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,63.72,24,,,percent of total billed charges,24% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,212.4,80,,,percent of total billed charges,80% of total billed charges ,64.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,133.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,64.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,71.31,26.86,,,percent of total billed charges,26.86% of total billed charges,63.72,24,,,percent of total billed charges,24% of total billed charges ,82.84,31.2,,,percent of total billed charges,31.2% of total billed charges,212.4,80,,,percent of total billed charges,80% of total billed charges,63.72,24,,,percent of total billed charges,24% of total billed charges ,63.72,24,,,percent of total billed charges,24% of total billed charges ,63.72,212.4,
US BREAST LT,4561201,CDM,402,RC,76642,HCPCS,Outpatient,,,306,153,,82.19,26.86,,,percent of total billed charges,26.86% of total billed charges,229.5,75,,,percent of total billed charges,75% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,73.44,24,,,percent of total billed charges,24% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,244.8,80,,,percent of total billed charges,80% of total billed charges ,74.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,154.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,74.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,82.19,26.86,,,percent of total billed charges,26.86% of total billed charges,73.44,24,,,percent of total billed charges,24% of total billed charges ,95.47,31.2,,,percent of total billed charges,31.2% of total billed charges,244.8,80,,,percent of total billed charges,80% of total billed charges,73.44,24,,,percent of total billed charges,24% of total billed charges ,73.44,24,,,percent of total billed charges,24% of total billed charges ,73.44,244.8,
US BREAST RT,4561202,CDM,402,RC,76642,HCPCS,Outpatient,,,306,153,,82.19,26.86,,,percent of total billed charges,26.86% of total billed charges,229.5,75,,,percent of total billed charges,75% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,73.44,24,,,percent of total billed charges,24% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,244.8,80,,,percent of total billed charges,80% of total billed charges ,74.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,154.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,74.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,82.19,26.86,,,percent of total billed charges,26.86% of total billed charges,73.44,24,,,percent of total billed charges,24% of total billed charges ,95.47,31.2,,,percent of total billed charges,31.2% of total billed charges,244.8,80,,,percent of total billed charges,80% of total billed charges,73.44,24,,,percent of total billed charges,24% of total billed charges ,73.44,24,,,percent of total billed charges,24% of total billed charges ,73.44,244.8,
US AXILLA LT,4561801,CDM,402,RC,76641,HCPCS,Outpatient,,,682,341,,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,545.6,80,,,percent of total billed charges,80% of total billed charges ,165.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,343.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,166.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,212.78,31.2,,,percent of total billed charges,31.2% of total billed charges,545.6,80,,,percent of total billed charges,80% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,545.6,
US AXILLA RT,4561802,CDM,402,RC,76641,HCPCS,Outpatient,,,682,341,,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,545.6,80,,,percent of total billed charges,80% of total billed charges ,165.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,343.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,166.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,212.78,31.2,,,percent of total billed charges,31.2% of total billed charges,545.6,80,,,percent of total billed charges,80% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,545.6,
US ECHOCARDIOGRAM,4590000,CDM,483,RC,93306,HCPCS,Outpatient,,,1897.5,948.75,,509.67,26.86,,,percent of total billed charges,26.86% of total billed charges,1423.13,75,,,percent of total billed charges,75% of total billed charges ,1423.13,75,,,percent of total billed charges,75% of total billed charges ,455.4,24,,,percent of total billed charges,24% of total billed charges ,1423.13,75,,,percent of total billed charges,75% of total billed charges ,1423.13,75,,,percent of total billed charges,75% of total billed charges ,1518,80,,,percent of total billed charges,80% of total billed charges ,459.95,24.24,,,percent of total billed charges,24.24% of total billed charges ,956.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,1423.13,75,,,percent of total billed charges,75% of total billed charges ,464.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,509.67,26.86,,,percent of total billed charges,26.86% of total billed charges,455.4,24,,,percent of total billed charges,24% of total billed charges ,592.02,31.2,,,percent of total billed charges,31.2% of total billed charges,1518,80,,,percent of total billed charges,80% of total billed charges,455.4,24,,,percent of total billed charges,24% of total billed charges ,455.4,24,,,percent of total billed charges,24% of total billed charges ,455.4,1518,
US ECHO STRESS,4590001,CDM,483,RC,93350,HCPCS,Outpatient,,,2086,1043,,560.3,26.86,,,percent of total billed charges,26.86% of total billed charges,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,500.64,24,,,percent of total billed charges,24% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1668.8,80,,,percent of total billed charges,80% of total billed charges ,505.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1051.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,510.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,560.3,26.86,,,percent of total billed charges,26.86% of total billed charges,500.64,24,,,percent of total billed charges,24% of total billed charges ,650.83,31.2,,,percent of total billed charges,31.2% of total billed charges,1668.8,80,,,percent of total billed charges,80% of total billed charges,500.64,24,,,percent of total billed charges,24% of total billed charges ,500.64,24,,,percent of total billed charges,24% of total billed charges ,500.64,1668.8,
US ARTERIAL BILAT,4590002,CDM,921,RC,93922,HCPCS,Outpatient,,,731.5,365.75,,196.48,26.86,,,percent of total billed charges,26.86% of total billed charges,548.63,75,,,percent of total billed charges,75% of total billed charges ,548.63,75,,,percent of total billed charges,75% of total billed charges ,175.56,24,,,percent of total billed charges,24% of total billed charges ,548.63,75,,,percent of total billed charges,75% of total billed charges ,548.63,75,,,percent of total billed charges,75% of total billed charges ,585.2,80,,,percent of total billed charges,80% of total billed charges ,177.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,368.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,548.63,75,,,percent of total billed charges,75% of total billed charges ,179.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,196.48,26.86,,,percent of total billed charges,26.86% of total billed charges,175.56,24,,,percent of total billed charges,24% of total billed charges ,228.23,31.2,,,percent of total billed charges,31.2% of total billed charges,585.2,80,,,percent of total billed charges,80% of total billed charges,175.56,24,,,percent of total billed charges,24% of total billed charges ,175.56,24,,,percent of total billed charges,24% of total billed charges ,175.56,585.2,
US CAROTIDS,4590003,CDM,921,RC,93880,HCPCS,Outpatient,,,545,272.5,,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,436,80,,,percent of total billed charges,80% of total billed charges ,132.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,274.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,133.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,170.04,31.2,,,percent of total billed charges,31.2% of total billed charges,436,80,,,percent of total billed charges,80% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,436,
US VENOUS DOPPLER EXTREMITY BIL,4590004,CDM,921,RC,93970,HCPCS,Outpatient,,,474,237,,127.32,26.86,,,percent of total billed charges,26.86% of total billed charges,355.5,75,,,percent of total billed charges,75% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,379.2,80,,,percent of total billed charges,80% of total billed charges ,114.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,238.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,116.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,127.32,26.86,,,percent of total billed charges,26.86% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,147.89,31.2,,,percent of total billed charges,31.2% of total billed charges,379.2,80,,,percent of total billed charges,80% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,379.2,
US ARTERIAL EXT BIL/ABI FOLLOWING STRESS,4590005,CDM,921,RC,93924,HCPCS,Outpatient,,,740.5,370.25,,198.9,26.86,,,percent of total billed charges,26.86% of total billed charges,555.38,75,,,percent of total billed charges,75% of total billed charges ,555.38,75,,,percent of total billed charges,75% of total billed charges ,177.72,24,,,percent of total billed charges,24% of total billed charges ,555.38,75,,,percent of total billed charges,75% of total billed charges ,555.38,75,,,percent of total billed charges,75% of total billed charges ,592.4,80,,,percent of total billed charges,80% of total billed charges ,179.5,24.24,,,percent of total billed charges,24.24% of total billed charges ,373.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,555.38,75,,,percent of total billed charges,75% of total billed charges ,181.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,198.9,26.86,,,percent of total billed charges,26.86% of total billed charges,177.72,24,,,percent of total billed charges,24% of total billed charges ,231.04,31.2,,,percent of total billed charges,31.2% of total billed charges,592.4,80,,,percent of total billed charges,80% of total billed charges,177.72,24,,,percent of total billed charges,24% of total billed charges ,177.72,24,,,percent of total billed charges,24% of total billed charges ,177.72,592.4,
US ECHO W/ BUBBLE STUDY,4590006,CDM,483,RC,93306,HCPCS,Outpatient,,,1897.5,948.75,,509.67,26.86,,,percent of total billed charges,26.86% of total billed charges,1423.13,75,,,percent of total billed charges,75% of total billed charges ,1423.13,75,,,percent of total billed charges,75% of total billed charges ,455.4,24,,,percent of total billed charges,24% of total billed charges ,1423.13,75,,,percent of total billed charges,75% of total billed charges ,1423.13,75,,,percent of total billed charges,75% of total billed charges ,1518,80,,,percent of total billed charges,80% of total billed charges ,459.95,24.24,,,percent of total billed charges,24.24% of total billed charges ,956.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,1423.13,75,,,percent of total billed charges,75% of total billed charges ,464.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,509.67,26.86,,,percent of total billed charges,26.86% of total billed charges,455.4,24,,,percent of total billed charges,24% of total billed charges ,592.02,31.2,,,percent of total billed charges,31.2% of total billed charges,1518,80,,,percent of total billed charges,80% of total billed charges,455.4,24,,,percent of total billed charges,24% of total billed charges ,455.4,24,,,percent of total billed charges,24% of total billed charges ,455.4,1518,
US SOFT TISSUE/NON VASCULAR,4590009,CDM,402,RC,76882,HCPCS,Outpatient,,,456.5,228.25,,122.62,26.86,,,percent of total billed charges,26.86% of total billed charges,342.38,75,,,percent of total billed charges,75% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,109.56,24,,,percent of total billed charges,24% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,365.2,80,,,percent of total billed charges,80% of total billed charges ,110.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,230.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,111.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,122.62,26.86,,,percent of total billed charges,26.86% of total billed charges,109.56,24,,,percent of total billed charges,24% of total billed charges ,142.43,31.2,,,percent of total billed charges,31.2% of total billed charges,365.2,80,,,percent of total billed charges,80% of total billed charges,109.56,24,,,percent of total billed charges,24% of total billed charges ,109.56,24,,,percent of total billed charges,24% of total billed charges ,109.56,365.2,
US CHEST,4590010,CDM,402,RC,76604,HCPCS,Outpatient,,,147.5,73.75,,39.62,26.86,,,percent of total billed charges,26.86% of total billed charges,110.63,75,,,percent of total billed charges,75% of total billed charges ,110.63,75,,,percent of total billed charges,75% of total billed charges ,35.4,24,,,percent of total billed charges,24% of total billed charges ,110.63,75,,,percent of total billed charges,75% of total billed charges ,110.63,75,,,percent of total billed charges,75% of total billed charges ,118,80,,,percent of total billed charges,80% of total billed charges ,35.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,74.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,110.63,75,,,percent of total billed charges,75% of total billed charges ,36.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,39.62,26.86,,,percent of total billed charges,26.86% of total billed charges,35.4,24,,,percent of total billed charges,24% of total billed charges ,46.02,31.2,,,percent of total billed charges,31.2% of total billed charges,118,80,,,percent of total billed charges,80% of total billed charges,35.4,24,,,percent of total billed charges,24% of total billed charges ,35.4,24,,,percent of total billed charges,24% of total billed charges ,35.4,118,
US PREGNANCY COMPLETE,4590011,CDM,402,RC,76801,HCPCS,Outpatient,,,445,222.5,,119.53,26.86,,,percent of total billed charges,26.86% of total billed charges,333.75,75,,,percent of total billed charges,75% of total billed charges ,333.75,75,,,percent of total billed charges,75% of total billed charges ,106.8,24,,,percent of total billed charges,24% of total billed charges ,333.75,75,,,percent of total billed charges,75% of total billed charges ,333.75,75,,,percent of total billed charges,75% of total billed charges ,356,80,,,percent of total billed charges,80% of total billed charges ,107.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,224.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,333.75,75,,,percent of total billed charges,75% of total billed charges ,108.94,24.48,,,percent of total billed charges,24.48% of total billed charges ,119.53,26.86,,,percent of total billed charges,26.86% of total billed charges,106.8,24,,,percent of total billed charges,24% of total billed charges ,138.84,31.2,,,percent of total billed charges,31.2% of total billed charges,356,80,,,percent of total billed charges,80% of total billed charges,106.8,24,,,percent of total billed charges,24% of total billed charges ,106.8,24,,,percent of total billed charges,24% of total billed charges ,106.8,356,
US VENOUS DOPPLER EXT UNI LT,4590013,CDM,921,RC,93971,HCPCS,Outpatient,,,474,237,,127.32,26.86,,,percent of total billed charges,26.86% of total billed charges,355.5,75,,,percent of total billed charges,75% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,379.2,80,,,percent of total billed charges,80% of total billed charges ,114.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,238.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,355.5,75,,,percent of total billed charges,75% of total billed charges ,116.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,127.32,26.86,,,percent of total billed charges,26.86% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,147.89,31.2,,,percent of total billed charges,31.2% of total billed charges,379.2,80,,,percent of total billed charges,80% of total billed charges,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,24,,,percent of total billed charges,24% of total billed charges ,113.76,379.2,
US VENOUS DOPPLER EXT UNI RT,4590014,CDM,921,RC,93971,HCPCS,Outpatient,,,545,272.5,,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,436,80,,,percent of total billed charges,80% of total billed charges ,132.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,274.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,133.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,146.39,26.86,,,percent of total billed charges,26.86% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,170.04,31.2,,,percent of total billed charges,31.2% of total billed charges,436,80,,,percent of total billed charges,80% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,436,
US AORTA SCREENING,4590015,CDM,402,RC,76706,HCPCS,Outpatient,,,682,341,,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,545.6,80,,,percent of total billed charges,80% of total billed charges ,165.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,343.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,511.5,75,,,percent of total billed charges,75% of total billed charges ,166.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,183.19,26.86,,,percent of total billed charges,26.86% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,212.78,31.2,,,percent of total billed charges,31.2% of total billed charges,545.6,80,,,percent of total billed charges,80% of total billed charges,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,24,,,percent of total billed charges,24% of total billed charges ,163.68,545.6,
MRI LOWER EXT OTHER THAN JOINT WWO LT,4700067,CDM,614,RC,73720,HCPCS,Outpatient,,,4267.5,2133.75,,1146.25,26.86,,,percent of total billed charges,26.86% of total billed charges,3200.63,75,,,percent of total billed charges,75% of total billed charges ,3200.63,75,,,percent of total billed charges,75% of total billed charges ,1024.2,24,,,percent of total billed charges,24% of total billed charges ,3200.63,75,,,percent of total billed charges,75% of total billed charges ,3200.63,75,,,percent of total billed charges,75% of total billed charges ,3414,80,,,percent of total billed charges,80% of total billed charges ,1034.44,24.24,,,percent of total billed charges,24.24% of total billed charges ,2150.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,3200.63,75,,,percent of total billed charges,75% of total billed charges ,1044.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.25,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.2,24,,,percent of total billed charges,24% of total billed charges ,1331.46,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,1024.2,24,,,percent of total billed charges,24% of total billed charges ,1024.2,24,,,percent of total billed charges,24% of total billed charges ,1024.2,3414,
CTA  ABDOMEN AND PELVIS W CONTRAST MATER,4700068,CDM,352,RC,74174,HCPCS,Outpatient,,,4243.5,2121.75,,1139.8,26.86,,,percent of total billed charges,26.86% of total billed charges,3182.63,75,,,percent of total billed charges,75% of total billed charges ,3182.63,75,,,percent of total billed charges,75% of total billed charges ,1018.44,24,,,percent of total billed charges,24% of total billed charges ,3182.63,75,,,percent of total billed charges,75% of total billed charges ,3182.63,75,,,percent of total billed charges,75% of total billed charges ,3394.8,80,,,percent of total billed charges,80% of total billed charges ,1028.62,24.24,,,percent of total billed charges,24.24% of total billed charges ,2138.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,3182.63,75,,,percent of total billed charges,75% of total billed charges ,1038.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,1139.8,26.86,,,percent of total billed charges,26.86% of total billed charges,1018.44,24,,,percent of total billed charges,24% of total billed charges ,1323.97,31.2,,,percent of total billed charges,31.2% of total billed charges,3394.8,80,,,percent of total billed charges,80% of total billed charges,1018.44,24,,,percent of total billed charges,24% of total billed charges ,1018.44,24,,,percent of total billed charges,24% of total billed charges ,1018.44,3394.8,
CT ABDOMEN WITH CONTRAST,4770000,CDM,352,RC,74160,HCPCS,Outpatient,,,3073.5,1536.75,,825.54,26.86,,,percent of total billed charges,26.86% of total billed charges,2305.13,75,,,percent of total billed charges,75% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,737.64,24,,,percent of total billed charges,24% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,2458.8,80,,,percent of total billed charges,80% of total billed charges ,745.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,1549.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,752.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,825.54,26.86,,,percent of total billed charges,26.86% of total billed charges,737.64,24,,,percent of total billed charges,24% of total billed charges ,958.93,31.2,,,percent of total billed charges,31.2% of total billed charges,2458.8,80,,,percent of total billed charges,80% of total billed charges,737.64,24,,,percent of total billed charges,24% of total billed charges ,737.64,24,,,percent of total billed charges,24% of total billed charges ,737.64,2458.8,
CT ABDOMEN WITHOUT CONTRAST,4770001,CDM,352,RC,74150,HCPCS,Outpatient,,,2561.5,1280.75,,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,2049.2,80,,,percent of total billed charges,80% of total billed charges ,620.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,1291,50.4,,,percent of total billed charges,50.4% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,627.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,799.19,31.2,,,percent of total billed charges,31.2% of total billed charges,2049.2,80,,,percent of total billed charges,80% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,2049.2,
CT ABDOMEN  WWO  CONTRAST,4770002,CDM,352,RC,74170,HCPCS,Outpatient,,,3319.5,1659.75,,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2655.6,80,,,percent of total billed charges,80% of total billed charges ,804.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1673.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,812.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,1035.68,31.2,,,percent of total billed charges,31.2% of total billed charges,2655.6,80,,,percent of total billed charges,80% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,2655.6,
CT CERVICAL SPINE WWO CONTRAST MATERIAL,4770003,CDM,352,RC,72127,HCPCS,Outpatient,,,3319.5,1659.75,,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2655.6,80,,,percent of total billed charges,80% of total billed charges ,804.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1673.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,812.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,1035.68,31.2,,,percent of total billed charges,31.2% of total billed charges,2655.6,80,,,percent of total billed charges,80% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,2655.6,
CT CERVICAL SPINE  WO CONTRAST MATERIAL,4770004,CDM,352,RC,72125,HCPCS,Outpatient,,,2561.5,1280.75,,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,2049.2,80,,,percent of total billed charges,80% of total billed charges ,620.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,1291,50.4,,,percent of total billed charges,50.4% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,627.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,799.19,31.2,,,percent of total billed charges,31.2% of total billed charges,2049.2,80,,,percent of total billed charges,80% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,2049.2,
CT CERVICAL SPINE W CONTRAST MATERIAL,4770005,CDM,352,RC,72126,HCPCS,Outpatient,,,2440,1220,,655.38,26.86,,,percent of total billed charges,26.86% of total billed charges,1830,75,,,percent of total billed charges,75% of total billed charges ,1830,75,,,percent of total billed charges,75% of total billed charges ,585.6,24,,,percent of total billed charges,24% of total billed charges ,1830,75,,,percent of total billed charges,75% of total billed charges ,1830,75,,,percent of total billed charges,75% of total billed charges ,1952,80,,,percent of total billed charges,80% of total billed charges ,591.46,24.24,,,percent of total billed charges,24.24% of total billed charges ,1229.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,1830,75,,,percent of total billed charges,75% of total billed charges ,597.31,24.48,,,percent of total billed charges,24.48% of total billed charges ,655.38,26.86,,,percent of total billed charges,26.86% of total billed charges,585.6,24,,,percent of total billed charges,24% of total billed charges ,761.28,31.2,,,percent of total billed charges,31.2% of total billed charges,1952,80,,,percent of total billed charges,80% of total billed charges,585.6,24,,,percent of total billed charges,24% of total billed charges ,585.6,24,,,percent of total billed charges,24% of total billed charges ,585.6,1952,
CT HEAD/BRAIN W CONT,4770006,CDM,351,RC,70460,HCPCS,Outpatient,,,2845,1422.5,,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2276,80,,,percent of total billed charges,80% of total billed charges ,689.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,1433.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,696.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,887.64,31.2,,,percent of total billed charges,31.2% of total billed charges,2276,80,,,percent of total billed charges,80% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,2276,
CT HEAD/BRAIN WWO CONT,4770007,CDM,351,RC,70470,HCPCS,Outpatient,,,3584.5,1792.25,,962.8,26.86,,,percent of total billed charges,26.86% of total billed charges,2688.38,75,,,percent of total billed charges,75% of total billed charges ,2688.38,75,,,percent of total billed charges,75% of total billed charges ,860.28,24,,,percent of total billed charges,24% of total billed charges ,2688.38,75,,,percent of total billed charges,75% of total billed charges ,2688.38,75,,,percent of total billed charges,75% of total billed charges ,2867.6,80,,,percent of total billed charges,80% of total billed charges ,868.88,24.24,,,percent of total billed charges,24.24% of total billed charges ,1806.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,2688.38,75,,,percent of total billed charges,75% of total billed charges ,877.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,962.8,26.86,,,percent of total billed charges,26.86% of total billed charges,860.28,24,,,percent of total billed charges,24% of total billed charges ,1118.36,31.2,,,percent of total billed charges,31.2% of total billed charges,2867.6,80,,,percent of total billed charges,80% of total billed charges,860.28,24,,,percent of total billed charges,24% of total billed charges ,860.28,24,,,percent of total billed charges,24% of total billed charges ,860.28,2867.6,
CT HEAD/BRAIN WO CONT,4770008,CDM,351,RC,70450,HCPCS,Outpatient,,,2561.5,1280.75,,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,2049.2,80,,,percent of total billed charges,80% of total billed charges ,620.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,1291,50.4,,,percent of total billed charges,50.4% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,627.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,799.19,31.2,,,percent of total billed charges,31.2% of total billed charges,2049.2,80,,,percent of total billed charges,80% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,2049.2,
CT LOWER EXTREMITY W CONTRAST RT,4770009,CDM,352,RC,73701,HCPCS,Outpatient,,,3073.5,1536.75,,825.54,26.86,,,percent of total billed charges,26.86% of total billed charges,2305.13,75,,,percent of total billed charges,75% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,737.64,24,,,percent of total billed charges,24% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,2458.8,80,,,percent of total billed charges,80% of total billed charges ,745.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,1549.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,752.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,825.54,26.86,,,percent of total billed charges,26.86% of total billed charges,737.64,24,,,percent of total billed charges,24% of total billed charges ,958.93,31.2,,,percent of total billed charges,31.2% of total billed charges,2458.8,80,,,percent of total billed charges,80% of total billed charges,737.64,24,,,percent of total billed charges,24% of total billed charges ,737.64,24,,,percent of total billed charges,24% of total billed charges ,737.64,2458.8,
CT LOWER EXTREMITY W CONTRAST LT,4770010,CDM,352,RC,73701,HCPCS,Outpatient,,,3073.5,1536.75,,825.54,26.86,,,percent of total billed charges,26.86% of total billed charges,2305.13,75,,,percent of total billed charges,75% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,737.64,24,,,percent of total billed charges,24% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,2458.8,80,,,percent of total billed charges,80% of total billed charges ,745.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,1549.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,752.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,825.54,26.86,,,percent of total billed charges,26.86% of total billed charges,737.64,24,,,percent of total billed charges,24% of total billed charges ,958.93,31.2,,,percent of total billed charges,31.2% of total billed charges,2458.8,80,,,percent of total billed charges,80% of total billed charges,737.64,24,,,percent of total billed charges,24% of total billed charges ,737.64,24,,,percent of total billed charges,24% of total billed charges ,737.64,2458.8,
CT LOWER EXT WO CONT LT,4770012,CDM,352,RC,73700,HCPCS,Outpatient,,,2561.5,1280.75,,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,2049.2,80,,,percent of total billed charges,80% of total billed charges ,620.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,1291,50.4,,,percent of total billed charges,50.4% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,627.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,799.19,31.2,,,percent of total billed charges,31.2% of total billed charges,2049.2,80,,,percent of total billed charges,80% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,2049.2,
CT LOWER EXT WO CONT RT,4770013,CDM,352,RC,73700,HCPCS,Outpatient,,,2561.5,1280.75,,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,2049.2,80,,,percent of total billed charges,80% of total billed charges ,620.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,1291,50.4,,,percent of total billed charges,50.4% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,627.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,799.19,31.2,,,percent of total billed charges,31.2% of total billed charges,2049.2,80,,,percent of total billed charges,80% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,2049.2,
CT LOWER EXT WWO CONT BIL,4770014,CDM,352,RC,73702,HCPCS,Outpatient,,,3319.5,1659.75,,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2655.6,80,,,percent of total billed charges,80% of total billed charges ,804.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1673.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,812.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,1035.68,31.2,,,percent of total billed charges,31.2% of total billed charges,2655.6,80,,,percent of total billed charges,80% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,2655.6,
CT LOWER EXT WWO CONT LT,4770015,CDM,352,RC,73702,HCPCS,Outpatient,,,3319.5,1659.75,,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2655.6,80,,,percent of total billed charges,80% of total billed charges ,804.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1673.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,812.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,1035.68,31.2,,,percent of total billed charges,31.2% of total billed charges,2655.6,80,,,percent of total billed charges,80% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,2655.6,
CT LOWER EXT WWO CONT RT,4770016,CDM,352,RC,73702,HCPCS,Outpatient,,,3319.5,1659.75,,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2655.6,80,,,percent of total billed charges,80% of total billed charges ,804.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1673.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,812.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,1035.68,31.2,,,percent of total billed charges,31.2% of total billed charges,2655.6,80,,,percent of total billed charges,80% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,2655.6,
CT LUMBAR SPINE  WWO CONTRAST MATERIAL,4770017,CDM,352,RC,72133,HCPCS,Outpatient,,,3319.5,1659.75,,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2655.6,80,,,percent of total billed charges,80% of total billed charges ,804.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1673.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,812.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,1035.68,31.2,,,percent of total billed charges,31.2% of total billed charges,2655.6,80,,,percent of total billed charges,80% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,2655.6,
CT LUMBAR SPINE WO CONTRAST MATERIAL,4770018,CDM,352,RC,72131,HCPCS,Outpatient,,,2561.5,1280.75,,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,2049.2,80,,,percent of total billed charges,80% of total billed charges ,620.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,1291,50.4,,,percent of total billed charges,50.4% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,627.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,799.19,31.2,,,percent of total billed charges,31.2% of total billed charges,2049.2,80,,,percent of total billed charges,80% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,2049.2,
CT PELVIS W CONTRAST,4770019,CDM,352,RC,72193,HCPCS,Outpatient,,,3073.5,1536.75,,825.54,26.86,,,percent of total billed charges,26.86% of total billed charges,2305.13,75,,,percent of total billed charges,75% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,737.64,24,,,percent of total billed charges,24% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,2458.8,80,,,percent of total billed charges,80% of total billed charges ,745.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,1549.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,752.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,825.54,26.86,,,percent of total billed charges,26.86% of total billed charges,737.64,24,,,percent of total billed charges,24% of total billed charges ,958.93,31.2,,,percent of total billed charges,31.2% of total billed charges,2458.8,80,,,percent of total billed charges,80% of total billed charges,737.64,24,,,percent of total billed charges,24% of total billed charges ,737.64,24,,,percent of total billed charges,24% of total billed charges ,737.64,2458.8,
CT PELVIS WWO CONTRAST,4770020,CDM,352,RC,72194,HCPCS,Outpatient,,,3319.5,1659.75,,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2655.6,80,,,percent of total billed charges,80% of total billed charges ,804.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1673.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,812.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,1035.68,31.2,,,percent of total billed charges,31.2% of total billed charges,2655.6,80,,,percent of total billed charges,80% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,2655.6,
CT PELVIS WO CONTRAST,4770021,CDM,352,RC,72192,HCPCS,Outpatient,,,2372,1186,,637.12,26.86,,,percent of total billed charges,26.86% of total billed charges,1779,75,,,percent of total billed charges,75% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,569.28,24,,,percent of total billed charges,24% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,1897.6,80,,,percent of total billed charges,80% of total billed charges ,574.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,1195.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,580.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,637.12,26.86,,,percent of total billed charges,26.86% of total billed charges,569.28,24,,,percent of total billed charges,24% of total billed charges ,740.06,31.2,,,percent of total billed charges,31.2% of total billed charges,1897.6,80,,,percent of total billed charges,80% of total billed charges,569.28,24,,,percent of total billed charges,24% of total billed charges ,569.28,24,,,percent of total billed charges,24% of total billed charges ,569.28,1897.6,
CT THORACIC SPINE WWO CONTRAST MATERIAL,4770022,CDM,352,RC,72130,HCPCS,Outpatient,,,3319.5,1659.75,,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2655.6,80,,,percent of total billed charges,80% of total billed charges ,804.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1673.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,812.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,1035.68,31.2,,,percent of total billed charges,31.2% of total billed charges,2655.6,80,,,percent of total billed charges,80% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,2655.6,
CT THORACIC SPINE WO CONTRAST MATERIAL,4770023,CDM,352,RC,72128,HCPCS,Outpatient,,,2561.5,1280.75,,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,2049.2,80,,,percent of total billed charges,80% of total billed charges ,620.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,1291,50.4,,,percent of total billed charges,50.4% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,627.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,799.19,31.2,,,percent of total billed charges,31.2% of total billed charges,2049.2,80,,,percent of total billed charges,80% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,2049.2,
CT UPPER EXT LTD W CONT BIL,4770024,CDM,352,RC,73201,HCPCS,Outpatient,,,2372,1186,,637.12,26.86,,,percent of total billed charges,26.86% of total billed charges,1779,75,,,percent of total billed charges,75% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,569.28,24,,,percent of total billed charges,24% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,1897.6,80,,,percent of total billed charges,80% of total billed charges ,574.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,1195.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,580.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,637.12,26.86,,,percent of total billed charges,26.86% of total billed charges,569.28,24,,,percent of total billed charges,24% of total billed charges ,740.06,31.2,,,percent of total billed charges,31.2% of total billed charges,1897.6,80,,,percent of total billed charges,80% of total billed charges,569.28,24,,,percent of total billed charges,24% of total billed charges ,569.28,24,,,percent of total billed charges,24% of total billed charges ,569.28,1897.6,
CT UPPER EXT WITH CONTRAST MATERIAL LT,4770025,CDM,352,RC,73201,HCPCS,Outpatient,,,2561.5,1280.75,,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,2049.2,80,,,percent of total billed charges,80% of total billed charges ,620.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,1291,50.4,,,percent of total billed charges,50.4% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,627.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,799.19,31.2,,,percent of total billed charges,31.2% of total billed charges,2049.2,80,,,percent of total billed charges,80% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,2049.2,
CT UPPER EXT  W CONTRAST RT,4770026,CDM,352,RC,73201,HCPCS,Outpatient,,,2561.5,1280.75,,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,2049.2,80,,,percent of total billed charges,80% of total billed charges ,620.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,1291,50.4,,,percent of total billed charges,50.4% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,627.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,799.19,31.2,,,percent of total billed charges,31.2% of total billed charges,2049.2,80,,,percent of total billed charges,80% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,2049.2,
CT UPPER EXT WWO CONT BIL,4770027,CDM,352,RC,73202,HCPCS,Outpatient,,,2845,1422.5,,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2276,80,,,percent of total billed charges,80% of total billed charges ,689.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,1433.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,696.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,887.64,31.2,,,percent of total billed charges,31.2% of total billed charges,2276,80,,,percent of total billed charges,80% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,2276,
CT UPPER EXT WWO CONT LT,4770028,CDM,352,RC,73202,HCPCS,Outpatient,,,2845,1422.5,,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2276,80,,,percent of total billed charges,80% of total billed charges ,689.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,1433.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,696.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,887.64,31.2,,,percent of total billed charges,31.2% of total billed charges,2276,80,,,percent of total billed charges,80% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,2276,
CT UPPER EXT WWO CONT RT,4770029,CDM,352,RC,73202,HCPCS,Outpatient,,,2845,1422.5,,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2276,80,,,percent of total billed charges,80% of total billed charges ,689.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,1433.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,696.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,887.64,31.2,,,percent of total billed charges,31.2% of total billed charges,2276,80,,,percent of total billed charges,80% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,2276,
CT UPPER EXT WO CONT BILAT,4770030,CDM,352,RC,73200,HCPCS,Outpatient,,,2372,1186,,637.12,26.86,,,percent of total billed charges,26.86% of total billed charges,1779,75,,,percent of total billed charges,75% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,569.28,24,,,percent of total billed charges,24% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,1897.6,80,,,percent of total billed charges,80% of total billed charges ,574.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,1195.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,580.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,637.12,26.86,,,percent of total billed charges,26.86% of total billed charges,569.28,24,,,percent of total billed charges,24% of total billed charges ,740.06,31.2,,,percent of total billed charges,31.2% of total billed charges,1897.6,80,,,percent of total billed charges,80% of total billed charges,569.28,24,,,percent of total billed charges,24% of total billed charges ,569.28,24,,,percent of total billed charges,24% of total billed charges ,569.28,1897.6,
CT UPPER EXT WO CONT LT,4770031,CDM,352,RC,73200,HCPCS,Outpatient,,,2372,1186,,637.12,26.86,,,percent of total billed charges,26.86% of total billed charges,1779,75,,,percent of total billed charges,75% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,569.28,24,,,percent of total billed charges,24% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,1897.6,80,,,percent of total billed charges,80% of total billed charges ,574.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,1195.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,580.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,637.12,26.86,,,percent of total billed charges,26.86% of total billed charges,569.28,24,,,percent of total billed charges,24% of total billed charges ,740.06,31.2,,,percent of total billed charges,31.2% of total billed charges,1897.6,80,,,percent of total billed charges,80% of total billed charges,569.28,24,,,percent of total billed charges,24% of total billed charges ,569.28,24,,,percent of total billed charges,24% of total billed charges ,569.28,1897.6,
CT UPPER EXT WO CONT RT,4770032,CDM,352,RC,73200,HCPCS,Outpatient,,,2372,1186,,637.12,26.86,,,percent of total billed charges,26.86% of total billed charges,1779,75,,,percent of total billed charges,75% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,569.28,24,,,percent of total billed charges,24% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,1897.6,80,,,percent of total billed charges,80% of total billed charges ,574.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,1195.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,580.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,637.12,26.86,,,percent of total billed charges,26.86% of total billed charges,569.28,24,,,percent of total billed charges,24% of total billed charges ,740.06,31.2,,,percent of total billed charges,31.2% of total billed charges,1897.6,80,,,percent of total billed charges,80% of total billed charges,569.28,24,,,percent of total billed charges,24% of total billed charges ,569.28,24,,,percent of total billed charges,24% of total billed charges ,569.28,1897.6,
CT INTERNAL AUDITORY CANAL,4770033,CDM,351,RC,70480,HCPCS,Outpatient,,,2845,1422.5,,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2276,80,,,percent of total billed charges,80% of total billed charges ,689.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,1433.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,696.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,887.64,31.2,,,percent of total billed charges,31.2% of total billed charges,2276,80,,,percent of total billed charges,80% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,2276,
CT ORBIT/IAC/MASTOIDS WITH CONTRAST MAT,4770034,CDM,351,RC,70481,HCPCS,Outpatient,,,2844,1422,,763.9,26.86,,,percent of total billed charges,26.86% of total billed charges,2133,75,,,percent of total billed charges,75% of total billed charges ,2133,75,,,percent of total billed charges,75% of total billed charges ,682.56,24,,,percent of total billed charges,24% of total billed charges ,2133,75,,,percent of total billed charges,75% of total billed charges ,2133,75,,,percent of total billed charges,75% of total billed charges ,2275.2,80,,,percent of total billed charges,80% of total billed charges ,689.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,1433.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,2133,75,,,percent of total billed charges,75% of total billed charges ,696.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,763.9,26.86,,,percent of total billed charges,26.86% of total billed charges,682.56,24,,,percent of total billed charges,24% of total billed charges ,887.33,31.2,,,percent of total billed charges,31.2% of total billed charges,2275.2,80,,,percent of total billed charges,80% of total billed charges,682.56,24,,,percent of total billed charges,24% of total billed charges ,682.56,24,,,percent of total billed charges,24% of total billed charges ,682.56,2275.2,
CT CHEST W CONTRAST MATERIAL,4770035,CDM,352,RC,71260,HCPCS,Outpatient,,,3073.5,1536.75,,825.54,26.86,,,percent of total billed charges,26.86% of total billed charges,2305.13,75,,,percent of total billed charges,75% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,737.64,24,,,percent of total billed charges,24% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,2458.8,80,,,percent of total billed charges,80% of total billed charges ,745.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,1549.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,2305.13,75,,,percent of total billed charges,75% of total billed charges ,752.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,825.54,26.86,,,percent of total billed charges,26.86% of total billed charges,737.64,24,,,percent of total billed charges,24% of total billed charges ,958.93,31.2,,,percent of total billed charges,31.2% of total billed charges,2458.8,80,,,percent of total billed charges,80% of total billed charges,737.64,24,,,percent of total billed charges,24% of total billed charges ,737.64,24,,,percent of total billed charges,24% of total billed charges ,737.64,2458.8,
CT CHEST WWO CONTRAST MATERIAL,4770036,CDM,352,RC,71270,HCPCS,Outpatient,,,3319.5,1659.75,,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2655.6,80,,,percent of total billed charges,80% of total billed charges ,804.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1673.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,812.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,1035.68,31.2,,,percent of total billed charges,31.2% of total billed charges,2655.6,80,,,percent of total billed charges,80% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,2655.6,
CT CHEST WO CONTRAST MATERIAL,4770037,CDM,352,RC,71250,HCPCS,Outpatient,,,2561.5,1280.75,,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,2049.2,80,,,percent of total billed charges,80% of total billed charges ,620.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,1291,50.4,,,percent of total billed charges,50.4% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,627.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,799.19,31.2,,,percent of total billed charges,31.2% of total billed charges,2049.2,80,,,percent of total billed charges,80% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,2049.2,
CT SOFT TISSUE NECK WITHOUT CONTRAST MAT,4770038,CDM,351,RC,70490,HCPCS,Outpatient,,,2561.5,1280.75,,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,2049.2,80,,,percent of total billed charges,80% of total billed charges ,620.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,1291,50.4,,,percent of total billed charges,50.4% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,627.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,799.19,31.2,,,percent of total billed charges,31.2% of total billed charges,2049.2,80,,,percent of total billed charges,80% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,2049.2,
CT SOFT TISSUE NECK WWO CONTRAST MATERIA,4770039,CDM,351,RC,70492,HCPCS,Outpatient,,,3584.5,1792.25,,962.8,26.86,,,percent of total billed charges,26.86% of total billed charges,2688.38,75,,,percent of total billed charges,75% of total billed charges ,2688.38,75,,,percent of total billed charges,75% of total billed charges ,860.28,24,,,percent of total billed charges,24% of total billed charges ,2688.38,75,,,percent of total billed charges,75% of total billed charges ,2688.38,75,,,percent of total billed charges,75% of total billed charges ,2867.6,80,,,percent of total billed charges,80% of total billed charges ,868.88,24.24,,,percent of total billed charges,24.24% of total billed charges ,1806.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,2688.38,75,,,percent of total billed charges,75% of total billed charges ,877.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,962.8,26.86,,,percent of total billed charges,26.86% of total billed charges,860.28,24,,,percent of total billed charges,24% of total billed charges ,1118.36,31.2,,,percent of total billed charges,31.2% of total billed charges,2867.6,80,,,percent of total billed charges,80% of total billed charges,860.28,24,,,percent of total billed charges,24% of total billed charges ,860.28,24,,,percent of total billed charges,24% of total billed charges ,860.28,2867.6,
CT THORACIC SPINE WITH CONTRAST MATERIAL,4770040,CDM,352,RC,72129,HCPCS,Outpatient,,,2845,1422.5,,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2276,80,,,percent of total billed charges,80% of total billed charges ,689.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,1433.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,696.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,887.64,31.2,,,percent of total billed charges,31.2% of total billed charges,2276,80,,,percent of total billed charges,80% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,2276,
CT LUMBAR  SPINE WITH CONTRAST MATERIAL,4770041,CDM,352,RC,72132,HCPCS,Outpatient,,,2845,1422.5,,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2276,80,,,percent of total billed charges,80% of total billed charges ,689.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,1433.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,696.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,887.64,31.2,,,percent of total billed charges,31.2% of total billed charges,2276,80,,,percent of total billed charges,80% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,2276,
CT ORBIT/IAC/MASTOIDS WO CONTRST MATERIA,4770042,CDM,351,RC,70480,HCPCS,Outpatient,,,2372,1186,,637.12,26.86,,,percent of total billed charges,26.86% of total billed charges,1779,75,,,percent of total billed charges,75% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,569.28,24,,,percent of total billed charges,24% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,1897.6,80,,,percent of total billed charges,80% of total billed charges ,574.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,1195.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,1779,75,,,percent of total billed charges,75% of total billed charges ,580.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,637.12,26.86,,,percent of total billed charges,26.86% of total billed charges,569.28,24,,,percent of total billed charges,24% of total billed charges ,740.06,31.2,,,percent of total billed charges,31.2% of total billed charges,1897.6,80,,,percent of total billed charges,80% of total billed charges,569.28,24,,,percent of total billed charges,24% of total billed charges ,569.28,24,,,percent of total billed charges,24% of total billed charges ,569.28,1897.6,
CT ORBIT/IAC/MASTOIDS  WWO CONTRAST,4770043,CDM,351,RC,70482,HCPCS,Outpatient,,,3319.5,1659.75,,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2655.6,80,,,percent of total billed charges,80% of total billed charges ,804.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1673.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,812.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,1035.68,31.2,,,percent of total billed charges,31.2% of total billed charges,2655.6,80,,,percent of total billed charges,80% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,2655.6,
CT MAX/FACIAL/SINUS WITHOUT CONTRAST,4770044,CDM,351,RC,70486,HCPCS,Outpatient,,,2561.5,1280.75,,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,2049.2,80,,,percent of total billed charges,80% of total billed charges ,620.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,1291,50.4,,,percent of total billed charges,50.4% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,627.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,799.19,31.2,,,percent of total billed charges,31.2% of total billed charges,2049.2,80,,,percent of total billed charges,80% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,2049.2,
CT MAX/FACIAL/SINUS W/WO CONTRAST MATE,4770045,CDM,351,RC,70488,HCPCS,Outpatient,,,3319.5,1659.75,,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2655.6,80,,,percent of total billed charges,80% of total billed charges ,804.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1673.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,812.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,1035.68,31.2,,,percent of total billed charges,31.2% of total billed charges,2655.6,80,,,percent of total billed charges,80% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,2655.6,
CT MAX/FACIAL/SINUS  WITH CONTRAST,4770046,CDM,351,RC,70487,HCPCS,Outpatient,,,2845,1422.5,,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2276,80,,,percent of total billed charges,80% of total billed charges ,689.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,1433.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,696.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,887.64,31.2,,,percent of total billed charges,31.2% of total billed charges,2276,80,,,percent of total billed charges,80% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,2276,
CT SOFT TISSUE NECK WITH CONTRAST MATERI,4770047,CDM,351,RC,70491,HCPCS,Outpatient,,,2845,1422.5,,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,2276,80,,,percent of total billed charges,80% of total billed charges ,689.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,1433.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,2133.75,75,,,percent of total billed charges,75% of total billed charges ,696.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,764.17,26.86,,,percent of total billed charges,26.86% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,887.64,31.2,,,percent of total billed charges,31.2% of total billed charges,2276,80,,,percent of total billed charges,80% of total billed charges,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,24,,,percent of total billed charges,24% of total billed charges ,682.8,2276,
CTA HEAD WITH CONTRAST,4770048,CDM,351,RC,70496,HCPCS,Outpatient,,,4609.5,2304.75,,1238.11,26.86,,,percent of total billed charges,26.86% of total billed charges,3457.13,75,,,percent of total billed charges,75% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,1106.28,24,,,percent of total billed charges,24% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,3687.6,80,,,percent of total billed charges,80% of total billed charges ,1117.34,24.24,,,percent of total billed charges,24.24% of total billed charges ,2323.19,50.4,,,percent of total billed charges,50.4% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,1128.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,1238.11,26.86,,,percent of total billed charges,26.86% of total billed charges,1106.28,24,,,percent of total billed charges,24% of total billed charges ,1438.16,31.2,,,percent of total billed charges,31.2% of total billed charges,3687.6,80,,,percent of total billed charges,80% of total billed charges,1106.28,24,,,percent of total billed charges,24% of total billed charges ,1106.28,24,,,percent of total billed charges,24% of total billed charges ,1106.28,3687.6,
CTA NECK WITH CONTRAST MATERIAL,4770049,CDM,351,RC,70498,HCPCS,Outpatient,,,4609.5,2304.75,,1238.11,26.86,,,percent of total billed charges,26.86% of total billed charges,3457.13,75,,,percent of total billed charges,75% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,1106.28,24,,,percent of total billed charges,24% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,3687.6,80,,,percent of total billed charges,80% of total billed charges ,1117.34,24.24,,,percent of total billed charges,24.24% of total billed charges ,2323.19,50.4,,,percent of total billed charges,50.4% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,1128.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,1238.11,26.86,,,percent of total billed charges,26.86% of total billed charges,1106.28,24,,,percent of total billed charges,24% of total billed charges ,1438.16,31.2,,,percent of total billed charges,31.2% of total billed charges,3687.6,80,,,percent of total billed charges,80% of total billed charges,1106.28,24,,,percent of total billed charges,24% of total billed charges ,1106.28,24,,,percent of total billed charges,24% of total billed charges ,1106.28,3687.6,
CTA ABDOMEN  WITH CONTRAST MATERIAL,4770050,CDM,352,RC,74175,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
CTA PELVIS WITH CONTRAST MATERIAL,4770051,CDM,352,RC,72191,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
CTA ABD AOR AND BIL LLIFEMORAL RUNOFF WI,4770052,CDM,352,RC,75635,HCPCS,Outpatient,,,5928.5,2964.25,,1592.4,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,1422.84,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4742.8,80,,,percent of total billed charges,80% of total billed charges ,1437.07,24.24,,,percent of total billed charges,24.24% of total billed charges ,2987.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,4446.38,75,,,percent of total billed charges,75% of total billed charges ,1451.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,1592.4,26.86,,,percent of total billed charges,26.86% of total billed charges,1422.84,24,,,percent of total billed charges,24% of total billed charges ,1849.69,31.2,,,percent of total billed charges,31.2% of total billed charges,4742.8,80,,,percent of total billed charges,80% of total billed charges,1422.84,24,,,percent of total billed charges,24% of total billed charges ,1422.84,24,,,percent of total billed charges,24% of total billed charges ,1422.84,4742.8,
CTA CHEST NONCORONARY WITH CONTRAST MATE,4770053,CDM,352,RC,71275,HCPCS,Outpatient,,,4609.5,2304.75,,1238.11,26.86,,,percent of total billed charges,26.86% of total billed charges,3457.13,75,,,percent of total billed charges,75% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,1106.28,24,,,percent of total billed charges,24% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,3687.6,80,,,percent of total billed charges,80% of total billed charges ,1117.34,24.24,,,percent of total billed charges,24.24% of total billed charges ,2323.19,50.4,,,percent of total billed charges,50.4% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,1128.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,1238.11,26.86,,,percent of total billed charges,26.86% of total billed charges,1106.28,24,,,percent of total billed charges,24% of total billed charges ,1438.16,31.2,,,percent of total billed charges,31.2% of total billed charges,3687.6,80,,,percent of total billed charges,80% of total billed charges,1106.28,24,,,percent of total billed charges,24% of total billed charges ,1106.28,24,,,percent of total billed charges,24% of total billed charges ,1106.28,3687.6,
CT UNSPECIFIED BODY REGION 3D RECONSTR,4770054,CDM,352,RC,76376,HCPCS,Outpatient,,,1031,515.5,,276.93,26.86,,,percent of total billed charges,26.86% of total billed charges,773.25,75,,,percent of total billed charges,75% of total billed charges ,773.25,75,,,percent of total billed charges,75% of total billed charges ,247.44,24,,,percent of total billed charges,24% of total billed charges ,773.25,75,,,percent of total billed charges,75% of total billed charges ,773.25,75,,,percent of total billed charges,75% of total billed charges ,824.8,80,,,percent of total billed charges,80% of total billed charges ,249.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,519.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,773.25,75,,,percent of total billed charges,75% of total billed charges ,252.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,276.93,26.86,,,percent of total billed charges,26.86% of total billed charges,247.44,24,,,percent of total billed charges,24% of total billed charges ,321.67,31.2,,,percent of total billed charges,31.2% of total billed charges,824.8,80,,,percent of total billed charges,80% of total billed charges,247.44,24,,,percent of total billed charges,24% of total billed charges ,247.44,24,,,percent of total billed charges,24% of total billed charges ,247.44,824.8,
CT ABDOMEN PELVIS WO CONTRAST,4770055,CDM,352,RC,74176,HCPCS,Outpatient,,,3841,1920.5,,1031.69,26.86,,,percent of total billed charges,26.86% of total billed charges,2880.75,75,,,percent of total billed charges,75% of total billed charges ,2880.75,75,,,percent of total billed charges,75% of total billed charges ,921.84,24,,,percent of total billed charges,24% of total billed charges ,2880.75,75,,,percent of total billed charges,75% of total billed charges ,2880.75,75,,,percent of total billed charges,75% of total billed charges ,3072.8,80,,,percent of total billed charges,80% of total billed charges ,931.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,1935.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,2880.75,75,,,percent of total billed charges,75% of total billed charges ,940.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,1031.69,26.86,,,percent of total billed charges,26.86% of total billed charges,921.84,24,,,percent of total billed charges,24% of total billed charges ,1198.39,31.2,,,percent of total billed charges,31.2% of total billed charges,3072.8,80,,,percent of total billed charges,80% of total billed charges,921.84,24,,,percent of total billed charges,24% of total billed charges ,921.84,24,,,percent of total billed charges,24% of total billed charges ,921.84,3072.8,
CT ABDOMEN PELVIS WITH  CONTRAST,4770056,CDM,352,RC,74177,HCPCS,Outpatient,,,4609.5,2304.75,,1238.11,26.86,,,percent of total billed charges,26.86% of total billed charges,3457.13,75,,,percent of total billed charges,75% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,1106.28,24,,,percent of total billed charges,24% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,3687.6,80,,,percent of total billed charges,80% of total billed charges ,1117.34,24.24,,,percent of total billed charges,24.24% of total billed charges ,2323.19,50.4,,,percent of total billed charges,50.4% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,1128.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,1238.11,26.86,,,percent of total billed charges,26.86% of total billed charges,1106.28,24,,,percent of total billed charges,24% of total billed charges ,1438.16,31.2,,,percent of total billed charges,31.2% of total billed charges,3687.6,80,,,percent of total billed charges,80% of total billed charges,1106.28,24,,,percent of total billed charges,24% of total billed charges ,1106.28,24,,,percent of total billed charges,24% of total billed charges ,1106.28,3687.6,
CT ABDOMEN PELVIS WWO  CONTRAST,4770057,CDM,352,RC,74178,HCPCS,Outpatient,,,5376.5,2688.25,,1444.13,26.86,,,percent of total billed charges,26.86% of total billed charges,4032.38,75,,,percent of total billed charges,75% of total billed charges ,4032.38,75,,,percent of total billed charges,75% of total billed charges ,1290.36,24,,,percent of total billed charges,24% of total billed charges ,4032.38,75,,,percent of total billed charges,75% of total billed charges ,4032.38,75,,,percent of total billed charges,75% of total billed charges ,4301.2,80,,,percent of total billed charges,80% of total billed charges ,1303.26,24.24,,,percent of total billed charges,24.24% of total billed charges ,2709.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,4032.38,75,,,percent of total billed charges,75% of total billed charges ,1316.17,24.48,,,percent of total billed charges,24.48% of total billed charges ,1444.13,26.86,,,percent of total billed charges,26.86% of total billed charges,1290.36,24,,,percent of total billed charges,24% of total billed charges ,1677.47,31.2,,,percent of total billed charges,31.2% of total billed charges,4301.2,80,,,percent of total billed charges,80% of total billed charges,1290.36,24,,,percent of total billed charges,24% of total billed charges ,1290.36,24,,,percent of total billed charges,24% of total billed charges ,1290.36,4301.2,
CT AORTA ANGIO W CONT,4770058,CDM,352,RC,74174,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
CTA LOWER EXTREMITY W CONTRAST LT,4770059,CDM,352,RC,73706,HCPCS,Outpatient,,,2844,1422,,763.9,26.86,,,percent of total billed charges,26.86% of total billed charges,2133,75,,,percent of total billed charges,75% of total billed charges ,2133,75,,,percent of total billed charges,75% of total billed charges ,682.56,24,,,percent of total billed charges,24% of total billed charges ,2133,75,,,percent of total billed charges,75% of total billed charges ,2133,75,,,percent of total billed charges,75% of total billed charges ,2275.2,80,,,percent of total billed charges,80% of total billed charges ,689.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,1433.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,2133,75,,,percent of total billed charges,75% of total billed charges ,696.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,763.9,26.86,,,percent of total billed charges,26.86% of total billed charges,682.56,24,,,percent of total billed charges,24% of total billed charges ,887.33,31.2,,,percent of total billed charges,31.2% of total billed charges,2275.2,80,,,percent of total billed charges,80% of total billed charges,682.56,24,,,percent of total billed charges,24% of total billed charges ,682.56,24,,,percent of total billed charges,24% of total billed charges ,682.56,2275.2,
CTA UPPER EXTREMITY W CONTRAST LT,4770060,CDM,352,RC,73206,HCPCS,Outpatient,,,2371,1185.5,,636.85,26.86,,,percent of total billed charges,26.86% of total billed charges,1778.25,75,,,percent of total billed charges,75% of total billed charges ,1778.25,75,,,percent of total billed charges,75% of total billed charges ,569.04,24,,,percent of total billed charges,24% of total billed charges ,1778.25,75,,,percent of total billed charges,75% of total billed charges ,1778.25,75,,,percent of total billed charges,75% of total billed charges ,1896.8,80,,,percent of total billed charges,80% of total billed charges ,574.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,1194.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,1778.25,75,,,percent of total billed charges,75% of total billed charges ,580.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,636.85,26.86,,,percent of total billed charges,26.86% of total billed charges,569.04,24,,,percent of total billed charges,24% of total billed charges ,739.75,31.2,,,percent of total billed charges,31.2% of total billed charges,1896.8,80,,,percent of total billed charges,80% of total billed charges,569.04,24,,,percent of total billed charges,24% of total billed charges ,569.04,24,,,percent of total billed charges,24% of total billed charges ,569.04,1896.8,
CTA UPPER EXTREMITY W CONTRAST RT,4770061,CDM,352,RC,73206,HCPCS,Outpatient,,,2371,1185.5,,636.85,26.86,,,percent of total billed charges,26.86% of total billed charges,1778.25,75,,,percent of total billed charges,75% of total billed charges ,1778.25,75,,,percent of total billed charges,75% of total billed charges ,569.04,24,,,percent of total billed charges,24% of total billed charges ,1778.25,75,,,percent of total billed charges,75% of total billed charges ,1778.25,75,,,percent of total billed charges,75% of total billed charges ,1896.8,80,,,percent of total billed charges,80% of total billed charges ,574.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,1194.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,1778.25,75,,,percent of total billed charges,75% of total billed charges ,580.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,636.85,26.86,,,percent of total billed charges,26.86% of total billed charges,569.04,24,,,percent of total billed charges,24% of total billed charges ,739.75,31.2,,,percent of total billed charges,31.2% of total billed charges,1896.8,80,,,percent of total billed charges,80% of total billed charges,569.04,24,,,percent of total billed charges,24% of total billed charges ,569.04,24,,,percent of total billed charges,24% of total billed charges ,569.04,1896.8,
CTA LOWER EXTREMITY W CONTRAST BIL,4770062,CDM,352,RC,73706,HCPCS,Outpatient,,,2844,1422,,763.9,26.86,,,percent of total billed charges,26.86% of total billed charges,2133,75,,,percent of total billed charges,75% of total billed charges ,2133,75,,,percent of total billed charges,75% of total billed charges ,682.56,24,,,percent of total billed charges,24% of total billed charges ,2133,75,,,percent of total billed charges,75% of total billed charges ,2133,75,,,percent of total billed charges,75% of total billed charges ,2275.2,80,,,percent of total billed charges,80% of total billed charges ,689.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,1433.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,2133,75,,,percent of total billed charges,75% of total billed charges ,696.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,763.9,26.86,,,percent of total billed charges,26.86% of total billed charges,682.56,24,,,percent of total billed charges,24% of total billed charges ,887.33,31.2,,,percent of total billed charges,31.2% of total billed charges,2275.2,80,,,percent of total billed charges,80% of total billed charges,682.56,24,,,percent of total billed charges,24% of total billed charges ,682.56,24,,,percent of total billed charges,24% of total billed charges ,682.56,2275.2,
CT ABDOMEN  WWO IV CONTRAST,4770063,CDM,352,RC,74170,HCPCS,Outpatient,,,3319.5,1659.75,,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2655.6,80,,,percent of total billed charges,80% of total billed charges ,804.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1673.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,812.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,1035.68,31.2,,,percent of total billed charges,31.2% of total billed charges,2655.6,80,,,percent of total billed charges,80% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,2655.6,
CT ABDOMEN  WWO ORAL/IV CONTRAST,4770064,CDM,352,RC,74170,HCPCS,Outpatient,,,3319.5,1659.75,,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,2655.6,80,,,percent of total billed charges,80% of total billed charges ,804.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1673.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,2489.63,75,,,percent of total billed charges,75% of total billed charges ,812.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,891.62,26.86,,,percent of total billed charges,26.86% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,1035.68,31.2,,,percent of total billed charges,31.2% of total billed charges,2655.6,80,,,percent of total billed charges,80% of total billed charges,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,24,,,percent of total billed charges,24% of total billed charges ,796.68,2655.6,
CT ABDOMEN PELVIS WWO  IV CONTRAST,4770065,CDM,352,RC,74178,HCPCS,Outpatient,,,4979,2489.5,,1337.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3734.25,75,,,percent of total billed charges,75% of total billed charges ,3734.25,75,,,percent of total billed charges,75% of total billed charges ,1194.96,24,,,percent of total billed charges,24% of total billed charges ,3734.25,75,,,percent of total billed charges,75% of total billed charges ,3734.25,75,,,percent of total billed charges,75% of total billed charges ,3983.2,80,,,percent of total billed charges,80% of total billed charges ,1206.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,2509.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,3734.25,75,,,percent of total billed charges,75% of total billed charges ,1218.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,1337.36,26.86,,,percent of total billed charges,26.86% of total billed charges,1194.96,24,,,percent of total billed charges,24% of total billed charges ,1553.45,31.2,,,percent of total billed charges,31.2% of total billed charges,3983.2,80,,,percent of total billed charges,80% of total billed charges,1194.96,24,,,percent of total billed charges,24% of total billed charges ,1194.96,24,,,percent of total billed charges,24% of total billed charges ,1194.96,3983.2,
CT ABDOMEN PELVIS WWO  ORAL/IV CONTRAST,4770066,CDM,352,RC,74178,HCPCS,Outpatient,,,4979,2489.5,,1337.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3734.25,75,,,percent of total billed charges,75% of total billed charges ,3734.25,75,,,percent of total billed charges,75% of total billed charges ,1194.96,24,,,percent of total billed charges,24% of total billed charges ,3734.25,75,,,percent of total billed charges,75% of total billed charges ,3734.25,75,,,percent of total billed charges,75% of total billed charges ,3983.2,80,,,percent of total billed charges,80% of total billed charges ,1206.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,2509.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,3734.25,75,,,percent of total billed charges,75% of total billed charges ,1218.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,1337.36,26.86,,,percent of total billed charges,26.86% of total billed charges,1194.96,24,,,percent of total billed charges,24% of total billed charges ,1553.45,31.2,,,percent of total billed charges,31.2% of total billed charges,3983.2,80,,,percent of total billed charges,80% of total billed charges,1194.96,24,,,percent of total billed charges,24% of total billed charges ,1194.96,24,,,percent of total billed charges,24% of total billed charges ,1194.96,3983.2,
CT GUIDED BIOPSY,4770067,CDM,352,RC,77012,HCPCS,Outpatient,,,1251.5,625.75,,336.15,26.86,,,percent of total billed charges,26.86% of total billed charges,938.63,75,,,percent of total billed charges,75% of total billed charges ,938.63,75,,,percent of total billed charges,75% of total billed charges ,300.36,24,,,percent of total billed charges,24% of total billed charges ,938.63,75,,,percent of total billed charges,75% of total billed charges ,938.63,75,,,percent of total billed charges,75% of total billed charges ,1001.2,80,,,percent of total billed charges,80% of total billed charges ,303.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,630.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,938.63,75,,,percent of total billed charges,75% of total billed charges ,306.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,336.15,26.86,,,percent of total billed charges,26.86% of total billed charges,300.36,24,,,percent of total billed charges,24% of total billed charges ,390.47,31.2,,,percent of total billed charges,31.2% of total billed charges,1001.2,80,,,percent of total billed charges,80% of total billed charges,300.36,24,,,percent of total billed charges,24% of total billed charges ,300.36,24,,,percent of total billed charges,24% of total billed charges ,300.36,1001.2,
CT THORAX LUNG CANCER SCREEN WO CONTRAST,4770068,CDM,352,RC,71271,HCPCS,Outpatient,,,2561.5,1280.75,,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,2049.2,80,,,percent of total billed charges,80% of total billed charges ,620.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,1291,50.4,,,percent of total billed charges,50.4% of total billed charges ,1921.13,75,,,percent of total billed charges,75% of total billed charges ,627.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,688.02,26.86,,,percent of total billed charges,26.86% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,799.19,31.2,,,percent of total billed charges,31.2% of total billed charges,2049.2,80,,,percent of total billed charges,80% of total billed charges,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,24,,,percent of total billed charges,24% of total billed charges ,614.76,2049.2,
COMPUTED TOMOGRAPHY BONE MINERAL DENSITY,4770069,CDM,352,RC,,,Outpatient,,,1167,583.5,,313.46,26.86,,,percent of total billed charges,26.86% of total billed charges,875.25,75,,,percent of total billed charges,75% of total billed charges ,875.25,75,,,percent of total billed charges,75% of total billed charges ,280.08,24,,,percent of total billed charges,24% of total billed charges ,875.25,75,,,percent of total billed charges,75% of total billed charges ,875.25,75,,,percent of total billed charges,75% of total billed charges ,933.6,80,,,percent of total billed charges,80% of total billed charges ,282.88,24.24,,,percent of total billed charges,24.24% of total billed charges ,588.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,875.25,75,,,percent of total billed charges,75% of total billed charges ,285.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,313.46,26.86,,,percent of total billed charges,26.86% of total billed charges,280.08,24,,,percent of total billed charges,24% of total billed charges ,364.1,31.2,,,percent of total billed charges,31.2% of total billed charges,933.6,80,,,percent of total billed charges,80% of total billed charges,280.08,24,,,percent of total billed charges,24% of total billed charges ,280.08,24,,,percent of total billed charges,24% of total billed charges ,280.08,933.6,
CT ENTEROGRAPHY,4770072,CDM,352,RC,74177,HCPCS,Outpatient,,,4609.5,2304.75,,1238.11,26.86,,,percent of total billed charges,26.86% of total billed charges,3457.13,75,,,percent of total billed charges,75% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,1106.28,24,,,percent of total billed charges,24% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,3687.6,80,,,percent of total billed charges,80% of total billed charges ,1117.34,24.24,,,percent of total billed charges,24.24% of total billed charges ,2323.19,50.4,,,percent of total billed charges,50.4% of total billed charges ,3457.13,75,,,percent of total billed charges,75% of total billed charges ,1128.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,1238.11,26.86,,,percent of total billed charges,26.86% of total billed charges,1106.28,24,,,percent of total billed charges,24% of total billed charges ,1438.16,31.2,,,percent of total billed charges,31.2% of total billed charges,3687.6,80,,,percent of total billed charges,80% of total billed charges,1106.28,24,,,percent of total billed charges,24% of total billed charges ,1106.28,24,,,percent of total billed charges,24% of total billed charges ,1106.28,3687.6,
3D RECONSTRUCTION REPORT OF CT,4770075,CDM,350,RC,76376,HCPCS,Outpatient,,,2334,1167,,626.91,26.86,,,percent of total billed charges,26.86% of total billed charges,1750.5,75,,,percent of total billed charges,75% of total billed charges ,1750.5,75,,,percent of total billed charges,75% of total billed charges ,560.16,24,,,percent of total billed charges,24% of total billed charges ,1750.5,75,,,percent of total billed charges,75% of total billed charges ,1750.5,75,,,percent of total billed charges,75% of total billed charges ,1867.2,80,,,percent of total billed charges,80% of total billed charges ,565.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,1176.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,1750.5,75,,,percent of total billed charges,75% of total billed charges ,571.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,626.91,26.86,,,percent of total billed charges,26.86% of total billed charges,560.16,24,,,percent of total billed charges,24% of total billed charges ,728.21,31.2,,,percent of total billed charges,31.2% of total billed charges,1867.2,80,,,percent of total billed charges,80% of total billed charges,560.16,24,,,percent of total billed charges,24% of total billed charges ,560.16,24,,,percent of total billed charges,24% of total billed charges ,560.16,1867.2,
3D RECONSTRUCTION CT REQ INDEPEND WS,4770079,CDM,350,RC,76377,HCPCS,Outpatient,,,3501,1750.5,,940.37,26.86,,,percent of total billed charges,26.86% of total billed charges,2625.75,75,,,percent of total billed charges,75% of total billed charges ,2625.75,75,,,percent of total billed charges,75% of total billed charges ,840.24,24,,,percent of total billed charges,24% of total billed charges ,2625.75,75,,,percent of total billed charges,75% of total billed charges ,2625.75,75,,,percent of total billed charges,75% of total billed charges ,2800.8,80,,,percent of total billed charges,80% of total billed charges ,848.64,24.24,,,percent of total billed charges,24.24% of total billed charges ,1764.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,2625.75,75,,,percent of total billed charges,75% of total billed charges ,857.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,940.37,26.86,,,percent of total billed charges,26.86% of total billed charges,840.24,24,,,percent of total billed charges,24% of total billed charges ,1092.31,31.2,,,percent of total billed charges,31.2% of total billed charges,2800.8,80,,,percent of total billed charges,80% of total billed charges,840.24,24,,,percent of total billed charges,24% of total billed charges ,840.24,24,,,percent of total billed charges,24% of total billed charges ,840.24,2800.8,
MRV BRAIN,4770103,CDM,615,RC,70544,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
CT CARDIAC SCORING,4770104,CDM,352,RC,75571,HCPCS,Outpatient,,,150,75,,40.29,26.86,,,percent of total billed charges,26.86% of total billed charges,112.5,75,,,percent of total billed charges,75% of total billed charges ,112.5,75,,,percent of total billed charges,75% of total billed charges ,36,24,,,percent of total billed charges,24% of total billed charges ,112.5,75,,,percent of total billed charges,75% of total billed charges ,112.5,75,,,percent of total billed charges,75% of total billed charges ,120,80,,,percent of total billed charges,80% of total billed charges ,36.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,75.6,50.4,,,percent of total billed charges,50.4% of total billed charges ,112.5,75,,,percent of total billed charges,75% of total billed charges ,36.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,40.29,26.86,,,percent of total billed charges,26.86% of total billed charges,36,24,,,percent of total billed charges,24% of total billed charges ,46.8,31.2,,,percent of total billed charges,31.2% of total billed charges,120,80,,,percent of total billed charges,80% of total billed charges,36,24,,,percent of total billed charges,24% of total billed charges ,36,24,,,percent of total billed charges,24% of total billed charges ,36,120,
BREAST SPECIMEN MAMMOGRAPHY,4827713,CDM,320,RC,76098,HCPCS,Outpatient,,,190.5,95.25,,51.17,26.86,,,percent of total billed charges,26.86% of total billed charges,142.88,75,,,percent of total billed charges,75% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,45.72,24,,,percent of total billed charges,24% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,152.4,80,,,percent of total billed charges,80% of total billed charges ,46.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,96.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,142.88,75,,,percent of total billed charges,75% of total billed charges ,46.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,51.17,26.86,,,percent of total billed charges,26.86% of total billed charges,45.72,24,,,percent of total billed charges,24% of total billed charges ,59.44,31.2,,,percent of total billed charges,31.2% of total billed charges,152.4,80,,,percent of total billed charges,80% of total billed charges,45.72,24,,,percent of total billed charges,24% of total billed charges ,45.72,24,,,percent of total billed charges,24% of total billed charges ,45.72,152.4,
NEEDLE LOCALIZATION MAMMOGRAPHY,4829902,CDM,361,RC,19281,HCPCS,Outpatient,,,593.5,296.75,,159.41,26.86,,,percent of total billed charges,26.86% of total billed charges,445.13,75,,,percent of total billed charges,75% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,142.44,24,,,percent of total billed charges,24% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,474.8,80,,,percent of total billed charges,80% of total billed charges ,143.86,24.24,,,percent of total billed charges,24.24% of total billed charges ,299.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,145.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,159.41,26.86,,,percent of total billed charges,26.86% of total billed charges,142.44,24,,,percent of total billed charges,24% of total billed charges ,185.17,31.2,,,percent of total billed charges,31.2% of total billed charges,474.8,80,,,percent of total billed charges,80% of total billed charges,142.44,24,,,percent of total billed charges,24% of total billed charges ,142.44,24,,,percent of total billed charges,24% of total billed charges ,142.44,474.8,
MM GUIDE NEEDLE LOCAL MASS OF BREAST,4829904,CDM,401,RC,19281,HCPCS,Outpatient,,,593.5,296.75,,159.41,26.86,,,percent of total billed charges,26.86% of total billed charges,445.13,75,,,percent of total billed charges,75% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,142.44,24,,,percent of total billed charges,24% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,474.8,80,,,percent of total billed charges,80% of total billed charges ,143.86,24.24,,,percent of total billed charges,24.24% of total billed charges ,299.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,145.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,159.41,26.86,,,percent of total billed charges,26.86% of total billed charges,142.44,24,,,percent of total billed charges,24% of total billed charges ,185.17,31.2,,,percent of total billed charges,31.2% of total billed charges,474.8,80,,,percent of total billed charges,80% of total billed charges,142.44,24,,,percent of total billed charges,24% of total billed charges ,142.44,24,,,percent of total billed charges,24% of total billed charges ,142.44,474.8,
MM GUIDE NEEDLE LOCAL MASS OF BREAST,4829905,CDM,401,RC,19281,HCPCS,Outpatient,,,593.5,296.75,,159.41,26.86,,,percent of total billed charges,26.86% of total billed charges,445.13,75,,,percent of total billed charges,75% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,142.44,24,,,percent of total billed charges,24% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,474.8,80,,,percent of total billed charges,80% of total billed charges ,143.86,24.24,,,percent of total billed charges,24.24% of total billed charges ,299.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,445.13,75,,,percent of total billed charges,75% of total billed charges ,145.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,159.41,26.86,,,percent of total billed charges,26.86% of total billed charges,142.44,24,,,percent of total billed charges,24% of total billed charges ,185.17,31.2,,,percent of total billed charges,31.2% of total billed charges,474.8,80,,,percent of total billed charges,80% of total billed charges,142.44,24,,,percent of total billed charges,24% of total billed charges ,142.44,24,,,percent of total billed charges,24% of total billed charges ,142.44,474.8,
MM BILATERAL DIAGNOSTIC MAMMOGRAM W/CAD,4880000,CDM,401,RC,77066,HCPCS,Outpatient,,,535.5,267.75,,143.84,26.86,,,percent of total billed charges,26.86% of total billed charges,401.63,75,,,percent of total billed charges,75% of total billed charges ,401.63,75,,,percent of total billed charges,75% of total billed charges ,128.52,24,,,percent of total billed charges,24% of total billed charges ,401.63,75,,,percent of total billed charges,75% of total billed charges ,401.63,75,,,percent of total billed charges,75% of total billed charges ,428.4,80,,,percent of total billed charges,80% of total billed charges ,129.81,24.24,,,percent of total billed charges,24.24% of total billed charges ,269.89,50.4,,,percent of total billed charges,50.4% of total billed charges ,401.63,75,,,percent of total billed charges,75% of total billed charges ,131.09,24.48,,,percent of total billed charges,24.48% of total billed charges ,143.84,26.86,,,percent of total billed charges,26.86% of total billed charges,128.52,24,,,percent of total billed charges,24% of total billed charges ,167.08,31.2,,,percent of total billed charges,31.2% of total billed charges,428.4,80,,,percent of total billed charges,80% of total billed charges,128.52,24,,,percent of total billed charges,24% of total billed charges ,128.52,24,,,percent of total billed charges,24% of total billed charges ,128.52,428.4,
MM UNILATERAL MAMMOGRAM LT W/CAD,4880001,CDM,401,RC,77065,HCPCS,Outpatient,,,424.5,212.25,,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,339.6,80,,,percent of total billed charges,80% of total billed charges ,102.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,213.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,103.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,132.44,31.2,,,percent of total billed charges,31.2% of total billed charges,339.6,80,,,percent of total billed charges,80% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,339.6,
MM UNILATERAL MAMMOGRAM W/CAD RT,4880002,CDM,401,RC,77065,HCPCS,Outpatient,,,424.5,212.25,,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,339.6,80,,,percent of total billed charges,80% of total billed charges ,102.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,213.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,103.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,132.44,31.2,,,percent of total billed charges,31.2% of total billed charges,339.6,80,,,percent of total billed charges,80% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,339.6,
MM BILATERAL SCREENING MAMMOGRAM W/CAD,4880003,CDM,403,RC,77067,HCPCS,Outpatient,,,456.5,228.25,,122.62,26.86,,,percent of total billed charges,26.86% of total billed charges,342.38,75,,,percent of total billed charges,75% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,109.56,24,,,percent of total billed charges,24% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,365.2,80,,,percent of total billed charges,80% of total billed charges ,110.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,230.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,111.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,122.62,26.86,,,percent of total billed charges,26.86% of total billed charges,109.56,24,,,percent of total billed charges,24% of total billed charges ,142.43,31.2,,,percent of total billed charges,31.2% of total billed charges,365.2,80,,,percent of total billed charges,80% of total billed charges,109.56,24,,,percent of total billed charges,24% of total billed charges ,109.56,24,,,percent of total billed charges,24% of total billed charges ,109.56,365.2,
MM BILATERAL DIAGNOSTIC BREAST TOMO,4880010,CDM,401,RC,77062,HCPCS,Outpatient,,,112.5,56.25,,30.22,26.86,,,percent of total billed charges,26.86% of total billed charges,84.38,75,,,percent of total billed charges,75% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,27,24,,,percent of total billed charges,24% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,90,80,,,percent of total billed charges,80% of total billed charges ,27.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,56.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,27.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.22,26.86,,,percent of total billed charges,26.86% of total billed charges,27,24,,,percent of total billed charges,24% of total billed charges ,35.1,31.2,,,percent of total billed charges,31.2% of total billed charges,90,80,,,percent of total billed charges,80% of total billed charges,27,24,,,percent of total billed charges,24% of total billed charges ,27,24,,,percent of total billed charges,24% of total billed charges ,27,90,
MM UNILATERAL DIAGNOSTIC BREAST TOMO LT,4880011,CDM,401,RC,77061,HCPCS,Outpatient,,,112.5,56.25,,30.22,26.86,,,percent of total billed charges,26.86% of total billed charges,84.38,75,,,percent of total billed charges,75% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,27,24,,,percent of total billed charges,24% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,90,80,,,percent of total billed charges,80% of total billed charges ,27.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,56.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,27.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.22,26.86,,,percent of total billed charges,26.86% of total billed charges,27,24,,,percent of total billed charges,24% of total billed charges ,35.1,31.2,,,percent of total billed charges,31.2% of total billed charges,90,80,,,percent of total billed charges,80% of total billed charges,27,24,,,percent of total billed charges,24% of total billed charges ,27,24,,,percent of total billed charges,24% of total billed charges ,27,90,
MM UNILATERAL DIAGNOSTIC BREAST TOMO RT,4880012,CDM,401,RC,77061,HCPCS,Outpatient,,,112.5,56.25,,30.22,26.86,,,percent of total billed charges,26.86% of total billed charges,84.38,75,,,percent of total billed charges,75% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,27,24,,,percent of total billed charges,24% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,90,80,,,percent of total billed charges,80% of total billed charges ,27.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,56.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,27.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.22,26.86,,,percent of total billed charges,26.86% of total billed charges,27,24,,,percent of total billed charges,24% of total billed charges ,35.1,31.2,,,percent of total billed charges,31.2% of total billed charges,90,80,,,percent of total billed charges,80% of total billed charges,27,24,,,percent of total billed charges,24% of total billed charges ,27,24,,,percent of total billed charges,24% of total billed charges ,27,90,
MM BILATERAL SCREENING BREAST TOMO,4880013,CDM,403,RC,77063,HCPCS,Outpatient,,,112.5,56.25,,30.22,26.86,,,percent of total billed charges,26.86% of total billed charges,84.38,75,,,percent of total billed charges,75% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,27,24,,,percent of total billed charges,24% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,90,80,,,percent of total billed charges,80% of total billed charges ,27.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,56.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,27.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.22,26.86,,,percent of total billed charges,26.86% of total billed charges,27,24,,,percent of total billed charges,24% of total billed charges ,35.1,31.2,,,percent of total billed charges,31.2% of total billed charges,90,80,,,percent of total billed charges,80% of total billed charges,27,24,,,percent of total billed charges,24% of total billed charges ,27,24,,,percent of total billed charges,24% of total billed charges ,27,90,
MRI BRAIN WITHOUT CONTRAST MATERIAL,4900001,CDM,611,RC,70551,HCPCS,Outpatient,,,3912,1956,,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,3129.6,80,,,percent of total billed charges,80% of total billed charges ,948.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,1971.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,957.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,1220.54,31.2,,,percent of total billed charges,31.2% of total billed charges,3129.6,80,,,percent of total billed charges,80% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,3129.6,
MRI HEAD WITH CONTRAST MATERIAL,4900002,CDM,611,RC,70552,HCPCS,Outpatient,,,4174.5,2087.25,,1121.27,26.86,,,percent of total billed charges,26.86% of total billed charges,3130.88,75,,,percent of total billed charges,75% of total billed charges ,3130.88,75,,,percent of total billed charges,75% of total billed charges ,1001.88,24,,,percent of total billed charges,24% of total billed charges ,3130.88,75,,,percent of total billed charges,75% of total billed charges ,3130.88,75,,,percent of total billed charges,75% of total billed charges ,3339.6,80,,,percent of total billed charges,80% of total billed charges ,1011.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,2103.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,3130.88,75,,,percent of total billed charges,75% of total billed charges ,1021.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,1121.27,26.86,,,percent of total billed charges,26.86% of total billed charges,1001.88,24,,,percent of total billed charges,24% of total billed charges ,1302.44,31.2,,,percent of total billed charges,31.2% of total billed charges,3339.6,80,,,percent of total billed charges,80% of total billed charges,1001.88,24,,,percent of total billed charges,24% of total billed charges ,1001.88,24,,,percent of total billed charges,24% of total billed charges ,1001.88,3339.6,
MRI HEAD WWO CONTRAST MATERIAL,4900003,CDM,611,RC,70553,HCPCS,Outpatient,,,4694.5,2347.25,,1260.94,26.86,,,percent of total billed charges,26.86% of total billed charges,3520.88,75,,,percent of total billed charges,75% of total billed charges ,3520.88,75,,,percent of total billed charges,75% of total billed charges ,1126.68,24,,,percent of total billed charges,24% of total billed charges ,3520.88,75,,,percent of total billed charges,75% of total billed charges ,3520.88,75,,,percent of total billed charges,75% of total billed charges ,3755.6,80,,,percent of total billed charges,80% of total billed charges ,1137.95,24.24,,,percent of total billed charges,24.24% of total billed charges ,2366.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,3520.88,75,,,percent of total billed charges,75% of total billed charges ,1149.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,1260.94,26.86,,,percent of total billed charges,26.86% of total billed charges,1126.68,24,,,percent of total billed charges,24% of total billed charges ,1464.68,31.2,,,percent of total billed charges,31.2% of total billed charges,3755.6,80,,,percent of total billed charges,80% of total billed charges,1126.68,24,,,percent of total billed charges,24% of total billed charges ,1126.68,24,,,percent of total billed charges,24% of total billed charges ,1126.68,3755.6,
MRI FACE ORBIT NECK WO CONTRAST MATERIAL,4900004,CDM,610,RC,70540,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,2845.2,80,,,percent of total billed charges,80% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRI FACE ORBIT NECK W CONTRAST MATERIAL,4900005,CDM,610,RC,70542,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI FACE ORBIT NECK WWO CONTRAST MATERIA,4900006,CDM,610,RC,70543,HCPCS,Outpatient,,,4694.5,2347.25,,1260.94,26.86,,,percent of total billed charges,26.86% of total billed charges,3520.88,75,,,percent of total billed charges,75% of total billed charges ,3520.88,75,,,percent of total billed charges,75% of total billed charges ,1126.68,24,,,percent of total billed charges,24% of total billed charges ,3520.88,75,,,percent of total billed charges,75% of total billed charges ,3520.88,75,,,percent of total billed charges,75% of total billed charges ,3755.6,80,,,percent of total billed charges,80% of total billed charges ,1137.95,24.24,,,percent of total billed charges,24.24% of total billed charges ,2366.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,3520.88,75,,,percent of total billed charges,75% of total billed charges ,1149.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,1260.94,26.86,,,percent of total billed charges,26.86% of total billed charges,1126.68,24,,,percent of total billed charges,24% of total billed charges ,1464.68,31.2,,,percent of total billed charges,31.2% of total billed charges,3755.6,80,,,percent of total billed charges,80% of total billed charges,1126.68,24,,,percent of total billed charges,24% of total billed charges ,1126.68,24,,,percent of total billed charges,24% of total billed charges ,1126.68,3755.6,
MRI CERVICAL SPINE WITHOUT CONTRAST,4900011,CDM,612,RC,72141,HCPCS,Outpatient,,,3912,1956,,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,3129.6,80,,,percent of total billed charges,80% of total billed charges ,948.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,1971.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,957.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,1220.54,31.2,,,percent of total billed charges,31.2% of total billed charges,3129.6,80,,,percent of total billed charges,80% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,3129.6,
MRI CERVICAL SPINE W CONTRAST MATERIAL,4900012,CDM,612,RC,72142,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI CERVICAL  SPINE WWO CONT MATERIAL,4900013,CDM,612,RC,72156,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI THORACIC SPINE WO CONTRAST MATERIAL,4900015,CDM,612,RC,72146,HCPCS,Outpatient,,,3912,1956,,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,3129.6,80,,,percent of total billed charges,80% of total billed charges ,948.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,1971.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,957.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,1220.54,31.2,,,percent of total billed charges,31.2% of total billed charges,3129.6,80,,,percent of total billed charges,80% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,3129.6,
MRI THORACIC SPINE W CONTRAST MATERIAL,4900016,CDM,612,RC,72147,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI THORACIC SPINE WWO CONT MATERIAL,4900017,CDM,612,RC,72157,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI LUMBAR SPINE WO CONTRAST MATERIAL,4900019,CDM,610,RC,72148,HCPCS,Outpatient,,,3912,1956,,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,3129.6,80,,,percent of total billed charges,80% of total billed charges ,948.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,1971.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,957.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,1220.54,31.2,,,percent of total billed charges,31.2% of total billed charges,3129.6,80,,,percent of total billed charges,80% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,3129.6,
MRI LUMBAR SPINE W CONTRAST MATERIAL,4900020,CDM,612,RC,72149,HCPCS,Outpatient,,,4174.5,2087.25,,1121.27,26.86,,,percent of total billed charges,26.86% of total billed charges,3130.88,75,,,percent of total billed charges,75% of total billed charges ,3130.88,75,,,percent of total billed charges,75% of total billed charges ,1001.88,24,,,percent of total billed charges,24% of total billed charges ,3130.88,75,,,percent of total billed charges,75% of total billed charges ,3130.88,75,,,percent of total billed charges,75% of total billed charges ,3339.6,80,,,percent of total billed charges,80% of total billed charges ,1011.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,2103.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,3130.88,75,,,percent of total billed charges,75% of total billed charges ,1021.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,1121.27,26.86,,,percent of total billed charges,26.86% of total billed charges,1001.88,24,,,percent of total billed charges,24% of total billed charges ,1302.44,31.2,,,percent of total billed charges,31.2% of total billed charges,3339.6,80,,,percent of total billed charges,80% of total billed charges,1001.88,24,,,percent of total billed charges,24% of total billed charges ,1001.88,24,,,percent of total billed charges,24% of total billed charges ,1001.88,3339.6,
MRI LUMBAR SPINE WWO CONT MATERIAL,4900021,CDM,612,RC,72158,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI CHEST WO CONTRAST MATERIAL,4900029,CDM,610,RC,71550,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,2845.2,80,,,percent of total billed charges,80% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRI CHEST W CONTRAST MATERIAL,4900030,CDM,610,RC,71551,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI CHEST WWO CONTRAST MATERIAL,4900031,CDM,610,RC,71552,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI BREAST UNIL WO CONT,4900032,CDM,610,RC,77046,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,2845.2,80,,,percent of total billed charges,80% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRI BREAST BIL WO CONT,4900033,CDM,610,RC,77047,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,2845.2,80,,,percent of total billed charges,80% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRI ABDOMEN WO CONTRAST MATERIAL,4900034,CDM,610,RC,74181,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,2845.2,80,,,percent of total billed charges,80% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRI ABDOMEN  W CONTRAST MATERIAL,4900035,CDM,610,RC,74182,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI ABDOMEN WWO CONTRAST MATERIAL,4900036,CDM,610,RC,74183,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI PELVIS/SACRUM/COCCYX WO CONTRAST,4900037,CDM,610,RC,72195,HCPCS,Outpatient,,,3912,1956,,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,3129.6,80,,,percent of total billed charges,80% of total billed charges ,948.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,1971.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,957.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,1220.54,31.2,,,percent of total billed charges,31.2% of total billed charges,3129.6,80,,,percent of total billed charges,80% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,3129.6,
MRI PELVIS/SACRUM/COCCYX WITH CONTRAST,4900039,CDM,610,RC,72196,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI PELVIS/SACRUM/COCCYX WWO,4900040,CDM,610,RC,72197,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI TEMPOROMANDIBULAR JOINT,4900041,CDM,610,RC,70336,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,2845.2,80,,,percent of total billed charges,80% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRI UPPER EXT OTHER THAN JOINT WWO LT,4900045,CDM,610,RC,73220,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI UPPER EXT JOINT BIL,4900049,CDM,610,RC,73221,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,2845.2,80,,,percent of total billed charges,80% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRI UPPER EXT JOINT WO CONTRAST LT,4900050,CDM,610,RC,73221,HCPCS,Outpatient,,,3912,1956,,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,3129.6,80,,,percent of total billed charges,80% of total billed charges ,948.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,1971.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,957.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,1220.54,31.2,,,percent of total billed charges,31.2% of total billed charges,3129.6,80,,,percent of total billed charges,80% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,3129.6,
MRI UPPER EXT JOINT WO CONTRAST RT,4900051,CDM,610,RC,73221,HCPCS,Outpatient,,,3912,1956,,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,3129.6,80,,,percent of total billed charges,80% of total billed charges ,948.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,1971.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,957.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,1220.54,31.2,,,percent of total billed charges,31.2% of total billed charges,3129.6,80,,,percent of total billed charges,80% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,3129.6,
MRI UPPER EXT OTHER THAN JOINT WO LT,4900052,CDM,610,RC,73218,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,2845.2,80,,,percent of total billed charges,80% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRI UPPER EXT W CONT BIL,4900053,CDM,610,RC,73219,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI UPPER EXT OTHER THAN JOINT W CON LT,4900054,CDM,610,RC,73219,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI UPPER EXT OTHER THAN JOINT W CON RT,4900055,CDM,610,RC,73219,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI UPPER EXT JOINT WWO CONT BIL,4900056,CDM,610,RC,73220,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI UPPER EXT JOINT WWO CONT LT,4900057,CDM,610,RC,73220,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI UPPER EXT OTHER THAN JOINT WWO RT,4900058,CDM,610,RC,73220,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI UPPER EXT JOINT W CONT BIL,4900059,CDM,610,RC,73222,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI UPPER EXT JOINT W CONT LT,4900060,CDM,614,RC,73222,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI UPPER EXT JOINT W CONT RT,4900061,CDM,614,RC,73222,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI LOWER EXT WO CONT BIL,4900062,CDM,610,RC,73718,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,2845.2,80,,,percent of total billed charges,80% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRI LOWER EXT OTHER THAN JOINT WO LT,4900063,CDM,610,RC,73718,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,2845.2,80,,,percent of total billed charges,80% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRI LOWER EXT OTHER THAN JOINT WO RT,4900064,CDM,610,RC,73718,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,2845.2,80,,,percent of total billed charges,80% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRI LOWER EXT W CONT BIL,4900065,CDM,610,RC,73719,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI LOWER EXT OTHER THAN JOINT W LT,4900066,CDM,610,RC,73719,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI LOWER EXT OTHER THAN JOINT W RT,4900067,CDM,610,RC,73719,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI LOWER EXT JOINT LTD BIL,4900068,CDM,610,RC,73721,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,2845.2,80,,,percent of total billed charges,80% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRI LOWER EXT JOINT WO CONTRAST LT,4900069,CDM,610,RC,73721,HCPCS,Outpatient,,,3912,1956,,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,3129.6,80,,,percent of total billed charges,80% of total billed charges ,948.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,1971.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,957.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,1220.54,31.2,,,percent of total billed charges,31.2% of total billed charges,3129.6,80,,,percent of total billed charges,80% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,3129.6,
MRI LOWER EXT JOINT WO CONTRAST RT,4900070,CDM,610,RC,73721,HCPCS,Outpatient,,,3912,1956,,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,3129.6,80,,,percent of total billed charges,80% of total billed charges ,948.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,1971.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,957.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,1220.54,31.2,,,percent of total billed charges,31.2% of total billed charges,3129.6,80,,,percent of total billed charges,80% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,3129.6,
MRA ABD WO CONTRAST MATERIAL,4900071,CDM,610,RC,74185,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,2845.2,80,,,percent of total billed charges,80% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRA HEAD WITHOUT CONTRAST MATERIAL,4900072,CDM,615,RC,70544,HCPCS,Outpatient,,,3912,1956,,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,3129.6,80,,,percent of total billed charges,80% of total billed charges ,948.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,1971.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,957.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,1220.54,31.2,,,percent of total billed charges,31.2% of total billed charges,3129.6,80,,,percent of total billed charges,80% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,3129.6,
MRI LOWER EXT VEINS ANGIO,4900073,CDM,610,RC,73725,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,2845.2,80,,,percent of total billed charges,80% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRA NECK WITHOUT CONTRAST MATERIAL,4900074,CDM,615,RC,70547,HCPCS,Outpatient,,,3912,1956,,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,3129.6,80,,,percent of total billed charges,80% of total billed charges ,948.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,1971.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,957.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,1220.54,31.2,,,percent of total billed charges,31.2% of total billed charges,3129.6,80,,,percent of total billed charges,80% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,3129.6,
MRA PELVIS  WWO CONT,4900075,CDM,619,RC,72198,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI LOWER EXT JOINT WWO CONT BIL,4900076,CDM,610,RC,73723,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI LOWER EXT JOINT WWO CONTRAST  LT,4900077,CDM,610,RC,73723,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI LOWER EXT JOINT WWO CONTRAST RT,4900078,CDM,610,RC,73723,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRA ABDOMEN WWO  CONTRAST,4900079,CDM,610,RC,74185,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRA ABDOMEN WWO CONTRAST MATERIAL,4900080,CDM,610,RC,74185,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRA HEAD WITH  CONTRAST MATERIAL,4900081,CDM,615,RC,70545,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRA HEAD  WWO CONTRAST MATERIAL,4900082,CDM,615,RC,70546,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI LOWER LEG VESSELS ANGIO W CONT,4900083,CDM,610,RC,73725,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI LOWER EXT VEINS ANGIO WWO CONT,4900084,CDM,610,RC,73725,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRA LOWER EXT WWO CONTRAST LT,4900085,CDM,610,RC,73725,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRA LOWER EXT WWO CONTRAST RT,4900086,CDM,610,RC,73725,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRA NECK WITH CONTRAST MATERIAL,4900087,CDM,615,RC,70548,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRA NECK WWO CONTRAST MATERIAL,4900088,CDM,615,RC,70549,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI BREAST UNIL W CONT,4900089,CDM,610,RC,C8906,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI BREAST BIL WWO CONT,4900090,CDM,610,RC,77049,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,2845.2,80,,,percent of total billed charges,80% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRI BREAST UNIL WWO CONT BIL,4900091,CDM,610,RC,C8905,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI BREAST UNIL  WWO CONTRAST LT,4900092,CDM,610,RC,77048,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI BREAST UNIL WWO CONTRAST RT,4900093,CDM,610,RC,77048,HCPCS,Outpatient,,,4268.5,2134.25,,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,3414.8,80,,,percent of total billed charges,80% of total billed charges ,1034.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,2151.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,3201.38,75,,,percent of total billed charges,75% of total billed charges ,1044.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.52,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1331.77,31.2,,,percent of total billed charges,31.2% of total billed charges,3414.8,80,,,percent of total billed charges,80% of total billed charges,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,24,,,percent of total billed charges,24% of total billed charges ,1024.44,3414.8,
MRI LOWER EXT JOINT W CONT BIL,4900094,CDM,610,RC,73722,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI LOWER EXT JOINT W CONTRAST  LT,4900095,CDM,614,RC,73722,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI LOWER EXT JOINT W CONTRAST RT,4900096,CDM,614,RC,73722,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI PITUITARY SELLA TURCICA,4900097,CDM,611,RC,70553,HCPCS,Outpatient,,,4694.5,2347.25,,1260.94,26.86,,,percent of total billed charges,26.86% of total billed charges,3520.88,75,,,percent of total billed charges,75% of total billed charges ,3520.88,75,,,percent of total billed charges,75% of total billed charges ,1126.68,24,,,percent of total billed charges,24% of total billed charges ,3520.88,75,,,percent of total billed charges,75% of total billed charges ,3520.88,75,,,percent of total billed charges,75% of total billed charges ,3755.6,80,,,percent of total billed charges,80% of total billed charges ,1137.95,24.24,,,percent of total billed charges,24.24% of total billed charges ,2366.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,3520.88,75,,,percent of total billed charges,75% of total billed charges ,1149.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,1260.94,26.86,,,percent of total billed charges,26.86% of total billed charges,1126.68,24,,,percent of total billed charges,24% of total billed charges ,1464.68,31.2,,,percent of total billed charges,31.2% of total billed charges,3755.6,80,,,percent of total billed charges,80% of total billed charges,1126.68,24,,,percent of total billed charges,24% of total billed charges ,1126.68,24,,,percent of total billed charges,24% of total billed charges ,1126.68,3755.6,
MRI WRIST WO CONT,4900098,CDM,610,RC,73221,HCPCS,Outpatient,,,3912,1956,,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,3129.6,80,,,percent of total billed charges,80% of total billed charges ,948.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,1971.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,2934,75,,,percent of total billed charges,75% of total billed charges ,957.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,1050.76,26.86,,,percent of total billed charges,26.86% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,1220.54,31.2,,,percent of total billed charges,31.2% of total billed charges,3129.6,80,,,percent of total billed charges,80% of total billed charges,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,24,,,percent of total billed charges,24% of total billed charges ,938.88,3129.6,
MRI WRIST W CONT,4900099,CDM,610,RC,73222,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRA UPPER EXT WWO CONT MAT LT,4900100,CDM,618,RC,73225,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRA UPPER EXT WWO CONT MAT RT,4900101,CDM,618,RC,73225,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRA UPPER EXT WWO CONT,4900102,CDM,618,RC,73225,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRI FOOT W CONT,4900103,CDM,610,RC,73719,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,3035.6,80,,,percent of total billed charges,80% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI ABD MRCP WO CONT,4900104,CDM,610,RC,74181,HCPCS,Outpatient,,,2334,1167,,626.91,26.86,,,percent of total billed charges,26.86% of total billed charges,1750.5,75,,,percent of total billed charges,75% of total billed charges ,1750.5,75,,,percent of total billed charges,75% of total billed charges ,560.16,24,,,percent of total billed charges,24% of total billed charges ,1750.5,75,,,percent of total billed charges,75% of total billed charges ,1750.5,75,,,percent of total billed charges,75% of total billed charges ,1867.2,80,,,percent of total billed charges,80% of total billed charges ,565.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,1176.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,1750.5,75,,,percent of total billed charges,75% of total billed charges ,571.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,626.91,26.86,,,percent of total billed charges,26.86% of total billed charges,560.16,24,,,percent of total billed charges,24% of total billed charges ,728.21,31.2,,,percent of total billed charges,31.2% of total billed charges,1867.2,80,,,percent of total billed charges,80% of total billed charges,560.16,24,,,percent of total billed charges,24% of total billed charges ,560.16,24,,,percent of total billed charges,24% of total billed charges ,560.16,1867.2,
MRI LIVER W CONT,4900105,CDM,610,RC,74183,HCPCS,Outpatient,,,2970.5,1485.25,,797.88,26.86,,,percent of total billed charges,26.86% of total billed charges,2227.88,75,,,percent of total billed charges,75% of total billed charges ,2227.88,75,,,percent of total billed charges,75% of total billed charges ,712.92,24,,,percent of total billed charges,24% of total billed charges ,2227.88,75,,,percent of total billed charges,75% of total billed charges ,2227.88,75,,,percent of total billed charges,75% of total billed charges ,2376.4,80,,,percent of total billed charges,80% of total billed charges ,720.05,24.24,,,percent of total billed charges,24.24% of total billed charges ,1497.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,2227.88,75,,,percent of total billed charges,75% of total billed charges ,727.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,797.88,26.86,,,percent of total billed charges,26.86% of total billed charges,712.92,24,,,percent of total billed charges,24% of total billed charges ,926.8,31.2,,,percent of total billed charges,31.2% of total billed charges,2376.4,80,,,percent of total billed charges,80% of total billed charges,712.92,24,,,percent of total billed charges,24% of total billed charges ,712.92,24,,,percent of total billed charges,24% of total billed charges ,712.92,2376.4,
MRI UPPER EXT OTHER THAN JOINT WO RT,4900106,CDM,610,RC,73218,HCPCS,Outpatient,,,3556.5,1778.25,,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,2845.2,80,,,percent of total billed charges,80% of total billed charges ,862.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1792.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,2667.38,75,,,percent of total billed charges,75% of total billed charges ,870.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,955.28,26.86,,,percent of total billed charges,26.86% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,1109.63,31.2,,,percent of total billed charges,31.2% of total billed charges,2845.2,80,,,percent of total billed charges,80% of total billed charges,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,24,,,percent of total billed charges,24% of total billed charges ,853.56,2845.2,
MRA CHEST EXCLUDING MYOCARD WWO CONTRAST,4900107,CDM,618,RC,71555,HCPCS,Outpatient,,,3760.5,1880.25,,1010.07,26.86,,,percent of total billed charges,26.86% of total billed charges,2820.38,75,,,percent of total billed charges,75% of total billed charges ,2820.38,75,,,percent of total billed charges,75% of total billed charges ,902.52,24,,,percent of total billed charges,24% of total billed charges ,2820.38,75,,,percent of total billed charges,75% of total billed charges ,2820.38,75,,,percent of total billed charges,75% of total billed charges ,3008.4,80,,,percent of total billed charges,80% of total billed charges ,911.55,24.24,,,percent of total billed charges,24.24% of total billed charges ,1895.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,2820.38,75,,,percent of total billed charges,75% of total billed charges ,920.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,1010.07,26.86,,,percent of total billed charges,26.86% of total billed charges,902.52,24,,,percent of total billed charges,24% of total billed charges ,1173.28,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,902.52,24,,,percent of total billed charges,24% of total billed charges ,902.52,24,,,percent of total billed charges,24% of total billed charges ,902.52,3008.4,
CERVICAL SPINE W FLEXION AND EXT VIEWS,4900108,CDM,320,RC,72052,HCPCS,Outpatient,,,456.5,228.25,,122.62,26.86,,,percent of total billed charges,26.86% of total billed charges,342.38,75,,,percent of total billed charges,75% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,109.56,24,,,percent of total billed charges,24% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,365.2,80,,,percent of total billed charges,80% of total billed charges ,110.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,230.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,342.38,75,,,percent of total billed charges,75% of total billed charges ,111.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,122.62,26.86,,,percent of total billed charges,26.86% of total billed charges,109.56,24,,,percent of total billed charges,24% of total billed charges ,142.43,31.2,,,percent of total billed charges,31.2% of total billed charges,365.2,80,,,percent of total billed charges,80% of total billed charges,109.56,24,,,percent of total billed charges,24% of total billed charges ,109.56,24,,,percent of total billed charges,24% of total billed charges ,109.56,365.2,
MRA SPINAL CANAL WWO CONTRAST MATERIAL,4900109,CDM,618,RC,72159,HCPCS,Outpatient,,,4031.5,2015.75,,1082.86,26.86,,,percent of total billed charges,26.86% of total billed charges,3023.63,75,,,percent of total billed charges,75% of total billed charges ,3023.63,75,,,percent of total billed charges,75% of total billed charges ,967.56,24,,,percent of total billed charges,24% of total billed charges ,3023.63,75,,,percent of total billed charges,75% of total billed charges ,3023.63,75,,,percent of total billed charges,75% of total billed charges ,3225.2,80,,,percent of total billed charges,80% of total billed charges ,977.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,2031.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,3023.63,75,,,percent of total billed charges,75% of total billed charges ,986.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,1082.86,26.86,,,percent of total billed charges,26.86% of total billed charges,967.56,24,,,percent of total billed charges,24% of total billed charges ,1257.83,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,967.56,24,,,percent of total billed charges,24% of total billed charges ,967.56,24,,,percent of total billed charges,24% of total billed charges ,967.56,3225.2,
MRA PELVIS WWO CONTRAST MATERIAL,4900110,CDM,618,RC,72198,HCPCS,Outpatient,,,3794.5,1897.25,,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,3035.6,80,,,percent of total billed charges,80% of total billed charges ,919.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,1912.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,2845.88,75,,,percent of total billed charges,75% of total billed charges ,928.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1019.2,26.86,,,percent of total billed charges,26.86% of total billed charges,910.68,24,,,percent of total billed charges,24% of total billed charges ,1183.88,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,24,,,percent of total billed charges,24% of total billed charges ,910.68,3035.6,
MRI UPPER EXTREMITY JOINT WWO CON MAT LT,4900111,CDM,610,RC,73223,HCPCS,Outpatient,,,4031.5,2015.75,,1082.86,26.86,,,percent of total billed charges,26.86% of total billed charges,3023.63,75,,,percent of total billed charges,75% of total billed charges ,3023.63,75,,,percent of total billed charges,75% of total billed charges ,967.56,24,,,percent of total billed charges,24% of total billed charges ,3023.63,75,,,percent of total billed charges,75% of total billed charges ,3023.63,75,,,percent of total billed charges,75% of total billed charges ,3225.2,80,,,percent of total billed charges,80% of total billed charges ,977.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,2031.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,3023.63,75,,,percent of total billed charges,75% of total billed charges ,986.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,1082.86,26.86,,,percent of total billed charges,26.86% of total billed charges,967.56,24,,,percent of total billed charges,24% of total billed charges ,1257.83,31.2,,,percent of total billed charges,31.2% of total billed charges,3225.2,80,,,percent of total billed charges,80% of total billed charges,967.56,24,,,percent of total billed charges,24% of total billed charges ,967.56,24,,,percent of total billed charges,24% of total billed charges ,967.56,3225.2,
MRI UPPER EXTREMITY JOINT WWO CON MAT RT,4900112,CDM,610,RC,73223,HCPCS,Outpatient,,,4031.5,2015.75,,1082.86,26.86,,,percent of total billed charges,26.86% of total billed charges,3023.63,75,,,percent of total billed charges,75% of total billed charges ,3023.63,75,,,percent of total billed charges,75% of total billed charges ,967.56,24,,,percent of total billed charges,24% of total billed charges ,3023.63,75,,,percent of total billed charges,75% of total billed charges ,3023.63,75,,,percent of total billed charges,75% of total billed charges ,3225.2,80,,,percent of total billed charges,80% of total billed charges ,977.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,2031.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,3023.63,75,,,percent of total billed charges,75% of total billed charges ,986.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,1082.86,26.86,,,percent of total billed charges,26.86% of total billed charges,967.56,24,,,percent of total billed charges,24% of total billed charges ,1257.83,31.2,,,percent of total billed charges,31.2% of total billed charges,3225.2,80,,,percent of total billed charges,80% of total billed charges,967.56,24,,,percent of total billed charges,24% of total billed charges ,967.56,24,,,percent of total billed charges,24% of total billed charges ,967.56,3225.2,
MRI BONE MARROW BLOOD SUPPLY,4900113,CDM,610,RC,77084,HCPCS,Outpatient,,,796,398,,213.81,26.86,,,percent of total billed charges,26.86% of total billed charges,597,75,,,percent of total billed charges,75% of total billed charges ,597,75,,,percent of total billed charges,75% of total billed charges ,191.04,24,,,percent of total billed charges,24% of total billed charges ,597,75,,,percent of total billed charges,75% of total billed charges ,597,75,,,percent of total billed charges,75% of total billed charges ,636.8,80,,,percent of total billed charges,80% of total billed charges ,192.95,24.24,,,percent of total billed charges,24.24% of total billed charges ,401.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,597,75,,,percent of total billed charges,75% of total billed charges ,194.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,213.81,26.86,,,percent of total billed charges,26.86% of total billed charges,191.04,24,,,percent of total billed charges,24% of total billed charges ,248.35,31.2,,,percent of total billed charges,31.2% of total billed charges,636.8,80,,,percent of total billed charges,80% of total billed charges,191.04,24,,,percent of total billed charges,24% of total billed charges ,191.04,24,,,percent of total billed charges,24% of total billed charges ,191.04,636.8,
ORBIT 1 VIEW FOR FOREGIN BODY LT,4920087,CDM,320,RC,70030,HCPCS,Outpatient,,,356.5,178.25,,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,285.2,
ORBIT 1 VIEW FOR FOREGIN BODY RT,4920088,CDM,320,RC,70030,HCPCS,Outpatient,,,356.5,178.25,,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,285.2,
MRI LOWER EXT OTHER THAN JOINT WWO RT,4920089,CDM,614,RC,73720,HCPCS,Outpatient,,,4267.5,2133.75,,1146.25,26.86,,,percent of total billed charges,26.86% of total billed charges,3200.63,75,,,percent of total billed charges,75% of total billed charges ,3200.63,75,,,percent of total billed charges,75% of total billed charges ,1024.2,24,,,percent of total billed charges,24% of total billed charges ,3200.63,75,,,percent of total billed charges,75% of total billed charges ,3200.63,75,,,percent of total billed charges,75% of total billed charges ,3414,80,,,percent of total billed charges,80% of total billed charges ,1034.44,24.24,,,percent of total billed charges,24.24% of total billed charges ,2150.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,3200.63,75,,,percent of total billed charges,75% of total billed charges ,1044.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.25,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.2,24,,,percent of total billed charges,24% of total billed charges ,1331.46,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,1024.2,24,,,percent of total billed charges,24% of total billed charges ,1024.2,24,,,percent of total billed charges,24% of total billed charges ,1024.2,3414,
MRI LOWER EXT OTHER THAN JOINT WWO LT,4920090,CDM,614,RC,73720,HCPCS,Outpatient,,,4267.5,2133.75,,1146.25,26.86,,,percent of total billed charges,26.86% of total billed charges,3200.63,75,,,percent of total billed charges,75% of total billed charges ,3200.63,75,,,percent of total billed charges,75% of total billed charges ,1024.2,24,,,percent of total billed charges,24% of total billed charges ,3200.63,75,,,percent of total billed charges,75% of total billed charges ,3200.63,75,,,percent of total billed charges,75% of total billed charges ,3414,80,,,percent of total billed charges,80% of total billed charges ,1034.44,24.24,,,percent of total billed charges,24.24% of total billed charges ,2150.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,3200.63,75,,,percent of total billed charges,75% of total billed charges ,1044.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,1146.25,26.86,,,percent of total billed charges,26.86% of total billed charges,1024.2,24,,,percent of total billed charges,24% of total billed charges ,1331.46,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,1024.2,24,,,percent of total billed charges,24% of total billed charges ,1024.2,24,,,percent of total billed charges,24% of total billed charges ,1024.2,3414,
NM THYROID SCAN AND UPTAKE,5040000,CDM,341,RC,78012,HCPCS,Outpatient,,,1596.5,798.25,,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1277.2,80,,,percent of total billed charges,80% of total billed charges ,386.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,804.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,390.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,498.11,31.2,,,percent of total billed charges,31.2% of total billed charges,1277.2,80,,,percent of total billed charges,80% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,1277.2,
NM PARATHYROID IMAGING,5040001,CDM,341,RC,78070,HCPCS,Outpatient,,,1596.5,798.25,,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1277.2,80,,,percent of total billed charges,80% of total billed charges ,386.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,804.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,390.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,498.11,31.2,,,percent of total billed charges,31.2% of total billed charges,1277.2,80,,,percent of total billed charges,80% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,1277.2,
NM PARATHYROID IMAGING W SPECT,5040002,CDM,341,RC,78071,HCPCS,Outpatient,,,1596.5,798.25,,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1277.2,80,,,percent of total billed charges,80% of total billed charges ,386.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,804.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,390.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,498.11,31.2,,,percent of total billed charges,31.2% of total billed charges,1277.2,80,,,percent of total billed charges,80% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,1277.2,
NM LIVER IMAGING STATIC ONLY,5040003,CDM,341,RC,78201,HCPCS,Outpatient,,,2086,1043,,560.3,26.86,,,percent of total billed charges,26.86% of total billed charges,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,500.64,24,,,percent of total billed charges,24% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1668.8,80,,,percent of total billed charges,80% of total billed charges ,505.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1051.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,510.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,560.3,26.86,,,percent of total billed charges,26.86% of total billed charges,500.64,24,,,percent of total billed charges,24% of total billed charges ,650.83,31.2,,,percent of total billed charges,31.2% of total billed charges,1668.8,80,,,percent of total billed charges,80% of total billed charges,500.64,24,,,percent of total billed charges,24% of total billed charges ,500.64,24,,,percent of total billed charges,24% of total billed charges ,500.64,1668.8,
NM LIVER IMAGING SPECT,5040004,CDM,341,RC,78803,HCPCS,Outpatient,,,5459,2729.5,,1466.29,26.86,,,percent of total billed charges,26.86% of total billed charges,4094.25,75,,,percent of total billed charges,75% of total billed charges ,4094.25,75,,,percent of total billed charges,75% of total billed charges ,1310.16,24,,,percent of total billed charges,24% of total billed charges ,4094.25,75,,,percent of total billed charges,75% of total billed charges ,4094.25,75,,,percent of total billed charges,75% of total billed charges ,4367.2,80,,,percent of total billed charges,80% of total billed charges ,1323.26,24.24,,,percent of total billed charges,24.24% of total billed charges ,2751.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,4094.25,75,,,percent of total billed charges,75% of total billed charges ,1336.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,1466.29,26.86,,,percent of total billed charges,26.86% of total billed charges,1310.16,24,,,percent of total billed charges,24% of total billed charges ,1703.21,31.2,,,percent of total billed charges,31.2% of total billed charges,4367.2,80,,,percent of total billed charges,80% of total billed charges,1310.16,24,,,percent of total billed charges,24% of total billed charges ,1310.16,24,,,percent of total billed charges,24% of total billed charges ,1310.16,4367.2,
NM LIVER SPLEEN IMAGING,5040005,CDM,341,RC,78215,HCPCS,Outpatient,,,1596.5,798.25,,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1277.2,80,,,percent of total billed charges,80% of total billed charges ,386.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,804.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,390.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,498.11,31.2,,,percent of total billed charges,31.2% of total billed charges,1277.2,80,,,percent of total billed charges,80% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,1277.2,
NM HEPATOBILIARY WO EF,5040006,CDM,341,RC,78226,HCPCS,Outpatient,,,1596.5,798.25,,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1277.2,80,,,percent of total billed charges,80% of total billed charges ,386.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,804.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,390.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,498.11,31.2,,,percent of total billed charges,31.2% of total billed charges,1277.2,80,,,percent of total billed charges,80% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,1277.2,
NM HEPATOBILIARY W EF,5040007,CDM,341,RC,78227,HCPCS,Outpatient,,,2086,1043,,560.3,26.86,,,percent of total billed charges,26.86% of total billed charges,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,500.64,24,,,percent of total billed charges,24% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1668.8,80,,,percent of total billed charges,80% of total billed charges ,505.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1051.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,510.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,560.3,26.86,,,percent of total billed charges,26.86% of total billed charges,500.64,24,,,percent of total billed charges,24% of total billed charges ,650.83,31.2,,,percent of total billed charges,31.2% of total billed charges,1668.8,80,,,percent of total billed charges,80% of total billed charges,500.64,24,,,percent of total billed charges,24% of total billed charges ,500.64,24,,,percent of total billed charges,24% of total billed charges ,500.64,1668.8,
NM GASTRIC EMPTYING,5040008,CDM,341,RC,78264,HCPCS,Outpatient,,,1596.5,798.25,,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1277.2,80,,,percent of total billed charges,80% of total billed charges ,386.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,804.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,390.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,498.11,31.2,,,percent of total billed charges,31.2% of total billed charges,1277.2,80,,,percent of total billed charges,80% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,1277.2,
NM LIMITED BONE SCAN,5040009,CDM,341,RC,78300,HCPCS,Outpatient,,,1596.5,798.25,,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1277.2,80,,,percent of total billed charges,80% of total billed charges ,386.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,804.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,390.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,498.11,31.2,,,percent of total billed charges,31.2% of total billed charges,1277.2,80,,,percent of total billed charges,80% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,1277.2,
NM WHOLE BODY BONE SCAN,5040010,CDM,341,RC,78306,HCPCS,Outpatient,,,1596.5,798.25,,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1277.2,80,,,percent of total billed charges,80% of total billed charges ,386.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,804.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,390.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,498.11,31.2,,,percent of total billed charges,31.2% of total billed charges,1277.2,80,,,percent of total billed charges,80% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,1277.2,
NM 3 PHASE BONE SCAN,5040011,CDM,341,RC,78315,HCPCS,Outpatient,,,1596.5,798.25,,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1277.2,80,,,percent of total billed charges,80% of total billed charges ,386.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,804.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,390.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,498.11,31.2,,,percent of total billed charges,31.2% of total billed charges,1277.2,80,,,percent of total billed charges,80% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,1277.2,
NM BONE SPECT,5040012,CDM,341,RC,78803,HCPCS,Outpatient,,,5459,2729.5,,1466.29,26.86,,,percent of total billed charges,26.86% of total billed charges,4094.25,75,,,percent of total billed charges,75% of total billed charges ,4094.25,75,,,percent of total billed charges,75% of total billed charges ,1310.16,24,,,percent of total billed charges,24% of total billed charges ,4094.25,75,,,percent of total billed charges,75% of total billed charges ,4094.25,75,,,percent of total billed charges,75% of total billed charges ,4367.2,80,,,percent of total billed charges,80% of total billed charges ,1323.26,24.24,,,percent of total billed charges,24.24% of total billed charges ,2751.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,4094.25,75,,,percent of total billed charges,75% of total billed charges ,1336.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,1466.29,26.86,,,percent of total billed charges,26.86% of total billed charges,1310.16,24,,,percent of total billed charges,24% of total billed charges ,1703.21,31.2,,,percent of total billed charges,31.2% of total billed charges,4367.2,80,,,percent of total billed charges,80% of total billed charges,1310.16,24,,,percent of total billed charges,24% of total billed charges ,1310.16,24,,,percent of total billed charges,24% of total billed charges ,1310.16,4367.2,
NM LIMITED BONE SCAN MULTIPLE AREAS,5040013,CDM,341,RC,78305,HCPCS,Outpatient,,,1596.5,798.25,,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1277.2,80,,,percent of total billed charges,80% of total billed charges ,386.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,804.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,390.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,498.11,31.2,,,percent of total billed charges,31.2% of total billed charges,1277.2,80,,,percent of total billed charges,80% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,1277.2,
NM MUGA,5040014,CDM,341,RC,78472,HCPCS,Outpatient,,,1596.5,798.25,,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1277.2,80,,,percent of total billed charges,80% of total billed charges ,386.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,804.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,390.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,498.11,31.2,,,percent of total billed charges,31.2% of total billed charges,1277.2,80,,,percent of total billed charges,80% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,1277.2,
NM QUANTITATIVE LUNG SCAN,5040015,CDM,341,RC,78597,HCPCS,Outpatient,,,1596.5,798.25,,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1277.2,80,,,percent of total billed charges,80% of total billed charges ,386.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,804.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,390.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,498.11,31.2,,,percent of total billed charges,31.2% of total billed charges,1277.2,80,,,percent of total billed charges,80% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,1277.2,
NM RENAL SCAN PLAIN,5040016,CDM,341,RC,78707,HCPCS,Outpatient,,,2086,1043,,560.3,26.86,,,percent of total billed charges,26.86% of total billed charges,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,500.64,24,,,percent of total billed charges,24% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1668.8,80,,,percent of total billed charges,80% of total billed charges ,505.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1051.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,510.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,560.3,26.86,,,percent of total billed charges,26.86% of total billed charges,500.64,24,,,percent of total billed charges,24% of total billed charges ,650.83,31.2,,,percent of total billed charges,31.2% of total billed charges,1668.8,80,,,percent of total billed charges,80% of total billed charges,500.64,24,,,percent of total billed charges,24% of total billed charges ,500.64,24,,,percent of total billed charges,24% of total billed charges ,500.64,1668.8,
NM RENAL SCAN CAPTOPRIL,5040017,CDM,341,RC,78708,HCPCS,Outpatient,,,2086,1043,,560.3,26.86,,,percent of total billed charges,26.86% of total billed charges,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,500.64,24,,,percent of total billed charges,24% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1668.8,80,,,percent of total billed charges,80% of total billed charges ,505.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1051.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,510.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,560.3,26.86,,,percent of total billed charges,26.86% of total billed charges,500.64,24,,,percent of total billed charges,24% of total billed charges ,650.83,31.2,,,percent of total billed charges,31.2% of total billed charges,1668.8,80,,,percent of total billed charges,80% of total billed charges,500.64,24,,,percent of total billed charges,24% of total billed charges ,500.64,24,,,percent of total billed charges,24% of total billed charges ,500.64,1668.8,
NM RENAL SCAN LASIX,5040018,CDM,341,RC,78708,HCPCS,Outpatient,,,424.5,212.25,,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,339.6,80,,,percent of total billed charges,80% of total billed charges ,102.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,213.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,103.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,132.44,31.2,,,percent of total billed charges,31.2% of total billed charges,339.6,80,,,percent of total billed charges,80% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,339.6,
NM HEMANGIOMA,5040019,CDM,341,RC,78803,HCPCS,Outpatient,,,1125,562.5,,302.18,26.86,,,percent of total billed charges,26.86% of total billed charges,843.75,75,,,percent of total billed charges,75% of total billed charges ,843.75,75,,,percent of total billed charges,75% of total billed charges ,270,24,,,percent of total billed charges,24% of total billed charges ,843.75,75,,,percent of total billed charges,75% of total billed charges ,843.75,75,,,percent of total billed charges,75% of total billed charges ,900,80,,,percent of total billed charges,80% of total billed charges ,272.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,567,50.4,,,percent of total billed charges,50.4% of total billed charges ,843.75,75,,,percent of total billed charges,75% of total billed charges ,275.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,302.18,26.86,,,percent of total billed charges,26.86% of total billed charges,270,24,,,percent of total billed charges,24% of total billed charges ,351,31.2,,,percent of total billed charges,31.2% of total billed charges,900,80,,,percent of total billed charges,80% of total billed charges,270,24,,,percent of total billed charges,24% of total billed charges ,270,24,,,percent of total billed charges,24% of total billed charges ,270,900,
NM LUNG SCAN VENTILATION IMAGES ONLY,5040020,CDM,341,RC,78579,HCPCS,Outpatient,,,1596.5,798.25,,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1277.2,80,,,percent of total billed charges,80% of total billed charges ,386.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,804.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,390.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,498.11,31.2,,,percent of total billed charges,31.2% of total billed charges,1277.2,80,,,percent of total billed charges,80% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,1277.2,
NM LUNG SCAN PERFUSION IMAGES ONLY,5040021,CDM,343,RC,78580,HCPCS,Outpatient,,,1596.5,798.25,,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1277.2,80,,,percent of total billed charges,80% of total billed charges ,386.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,804.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,390.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,498.11,31.2,,,percent of total billed charges,31.2% of total billed charges,1277.2,80,,,percent of total billed charges,80% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,1277.2,
NM PULMONARY VENTILATION PERFUSION IMA,5040022,CDM,343,RC,78582,HCPCS,Outpatient,,,2086,1043,,560.3,26.86,,,percent of total billed charges,26.86% of total billed charges,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,500.64,24,,,percent of total billed charges,24% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,1668.8,80,,,percent of total billed charges,80% of total billed charges ,505.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,1051.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,1564.5,75,,,percent of total billed charges,75% of total billed charges ,510.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,560.3,26.86,,,percent of total billed charges,26.86% of total billed charges,500.64,24,,,percent of total billed charges,24% of total billed charges ,650.83,31.2,,,percent of total billed charges,31.2% of total billed charges,1668.8,80,,,percent of total billed charges,80% of total billed charges,500.64,24,,,percent of total billed charges,24% of total billed charges ,500.64,24,,,percent of total billed charges,24% of total billed charges ,500.64,1668.8,
NM WBC IMAGING,5040023,CDM,343,RC,78800,HCPCS,Outpatient,,,1114.5,557.25,,299.35,26.86,,,percent of total billed charges,26.86% of total billed charges,835.88,75,,,percent of total billed charges,75% of total billed charges ,835.88,75,,,percent of total billed charges,75% of total billed charges ,267.48,24,,,percent of total billed charges,24% of total billed charges ,835.88,75,,,percent of total billed charges,75% of total billed charges ,835.88,75,,,percent of total billed charges,75% of total billed charges ,891.6,80,,,percent of total billed charges,80% of total billed charges ,270.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,561.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,835.88,75,,,percent of total billed charges,75% of total billed charges ,272.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,299.35,26.86,,,percent of total billed charges,26.86% of total billed charges,267.48,24,,,percent of total billed charges,24% of total billed charges ,347.72,31.2,,,percent of total billed charges,31.2% of total billed charges,891.6,80,,,percent of total billed charges,80% of total billed charges,267.48,24,,,percent of total billed charges,24% of total billed charges ,267.48,24,,,percent of total billed charges,24% of total billed charges ,267.48,891.6,
NM CARDIAC REST/STRESS,5040024,CDM,343,RC,78452,HCPCS,Outpatient,,,5459,2729.5,,1466.29,26.86,,,percent of total billed charges,26.86% of total billed charges,4094.25,75,,,percent of total billed charges,75% of total billed charges ,4094.25,75,,,percent of total billed charges,75% of total billed charges ,1310.16,24,,,percent of total billed charges,24% of total billed charges ,4094.25,75,,,percent of total billed charges,75% of total billed charges ,4094.25,75,,,percent of total billed charges,75% of total billed charges ,4367.2,80,,,percent of total billed charges,80% of total billed charges ,1323.26,24.24,,,percent of total billed charges,24.24% of total billed charges ,2751.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,4094.25,75,,,percent of total billed charges,75% of total billed charges ,1336.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,1466.29,26.86,,,percent of total billed charges,26.86% of total billed charges,1310.16,24,,,percent of total billed charges,24% of total billed charges ,1703.21,31.2,,,percent of total billed charges,31.2% of total billed charges,4367.2,80,,,percent of total billed charges,80% of total billed charges,1310.16,24,,,percent of total billed charges,24% of total billed charges ,1310.16,24,,,percent of total billed charges,24% of total billed charges ,1310.16,4367.2,
NM CARDIAC NUCLEAR STRESS TESTING,5040025,CDM,343,RC,93015,HCPCS,Outpatient,,,1591.5,795.75,,427.48,26.86,,,percent of total billed charges,26.86% of total billed charges,1193.63,75,,,percent of total billed charges,75% of total billed charges ,1193.63,75,,,percent of total billed charges,75% of total billed charges ,381.96,24,,,percent of total billed charges,24% of total billed charges ,1193.63,75,,,percent of total billed charges,75% of total billed charges ,1193.63,75,,,percent of total billed charges,75% of total billed charges ,1273.2,80,,,percent of total billed charges,80% of total billed charges ,385.78,24.24,,,percent of total billed charges,24.24% of total billed charges ,802.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,1193.63,75,,,percent of total billed charges,75% of total billed charges ,389.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,427.48,26.86,,,percent of total billed charges,26.86% of total billed charges,381.96,24,,,percent of total billed charges,24% of total billed charges ,496.55,31.2,,,percent of total billed charges,31.2% of total billed charges,1273.2,80,,,percent of total billed charges,80% of total billed charges,381.96,24,,,percent of total billed charges,24% of total billed charges ,381.96,24,,,percent of total billed charges,24% of total billed charges ,381.96,1273.2,
TC-99M SESTAMIBI,5040026,CDM,343,RC,A9500,HCPCS,Outpatient,,,400.5,200.25,,107.57,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,96.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,320.4,80,,,percent of total billed charges,80% of total billed charges ,97.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,201.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,300.38,75,,,percent of total billed charges,75% of total billed charges ,98.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,107.57,26.86,,,percent of total billed charges,26.86% of total billed charges,96.12,24,,,percent of total billed charges,24% of total billed charges ,124.96,31.2,,,percent of total billed charges,31.2% of total billed charges,320.4,80,,,percent of total billed charges,80% of total billed charges,96.12,24,,,percent of total billed charges,24% of total billed charges ,96.12,24,,,percent of total billed charges,24% of total billed charges ,96.12,320.4,
TC-99M MDP,5040027,CDM,343,RC,A9503,HCPCS,Outpatient,,,124.5,62.25,,33.44,26.86,,,percent of total billed charges,26.86% of total billed charges,93.38,75,,,percent of total billed charges,75% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,29.88,24,,,percent of total billed charges,24% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,99.6,80,,,percent of total billed charges,80% of total billed charges ,30.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,62.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,30.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,33.44,26.86,,,percent of total billed charges,26.86% of total billed charges,29.88,24,,,percent of total billed charges,24% of total billed charges ,38.84,31.2,,,percent of total billed charges,31.2% of total billed charges,99.6,80,,,percent of total billed charges,80% of total billed charges,29.88,24,,,percent of total billed charges,24% of total billed charges ,29.88,24,,,percent of total billed charges,24% of total billed charges ,29.88,99.6,
IODINE -123,5040028,CDM,343,RC,A9509,HCPCS,Outpatient,,,414,207,,111.2,26.86,,,percent of total billed charges,26.86% of total billed charges,310.5,75,,,percent of total billed charges,75% of total billed charges ,310.5,75,,,percent of total billed charges,75% of total billed charges ,99.36,24,,,percent of total billed charges,24% of total billed charges ,310.5,75,,,percent of total billed charges,75% of total billed charges ,310.5,75,,,percent of total billed charges,75% of total billed charges ,331.2,80,,,percent of total billed charges,80% of total billed charges ,100.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,208.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,310.5,75,,,percent of total billed charges,75% of total billed charges ,101.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,111.2,26.86,,,percent of total billed charges,26.86% of total billed charges,99.36,24,,,percent of total billed charges,24% of total billed charges ,129.17,31.2,,,percent of total billed charges,31.2% of total billed charges,331.2,80,,,percent of total billed charges,80% of total billed charges,99.36,24,,,percent of total billed charges,24% of total billed charges ,99.36,24,,,percent of total billed charges,24% of total billed charges ,99.36,331.2,
TC-99M CERETEC,5040029,CDM,343,RC,A9521,HCPCS,Outpatient,,,5040,2520,,1353.74,26.86,,,percent of total billed charges,26.86% of total billed charges,3780,75,,,percent of total billed charges,75% of total billed charges ,3780,75,,,percent of total billed charges,75% of total billed charges ,1209.6,24,,,percent of total billed charges,24% of total billed charges ,3780,75,,,percent of total billed charges,75% of total billed charges ,3780,75,,,percent of total billed charges,75% of total billed charges ,4032,80,,,percent of total billed charges,80% of total billed charges ,1221.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,2540.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,3780,75,,,percent of total billed charges,75% of total billed charges ,1233.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,1353.74,26.86,,,percent of total billed charges,26.86% of total billed charges,1209.6,24,,,percent of total billed charges,24% of total billed charges ,1572.48,31.2,,,percent of total billed charges,31.2% of total billed charges,4032,80,,,percent of total billed charges,80% of total billed charges,1209.6,24,,,percent of total billed charges,24% of total billed charges ,1209.6,24,,,percent of total billed charges,24% of total billed charges ,1209.6,4032,
TC-99MMEBROFENIN,5040030,CDM,343,RC,A9537,HCPCS,Outpatient,,,306,153,,82.19,26.86,,,percent of total billed charges,26.86% of total billed charges,229.5,75,,,percent of total billed charges,75% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,73.44,24,,,percent of total billed charges,24% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,244.8,80,,,percent of total billed charges,80% of total billed charges ,74.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,154.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,229.5,75,,,percent of total billed charges,75% of total billed charges ,74.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,82.19,26.86,,,percent of total billed charges,26.86% of total billed charges,73.44,24,,,percent of total billed charges,24% of total billed charges ,95.47,31.2,,,percent of total billed charges,31.2% of total billed charges,244.8,80,,,percent of total billed charges,80% of total billed charges,73.44,24,,,percent of total billed charges,24% of total billed charges ,73.44,24,,,percent of total billed charges,24% of total billed charges ,73.44,244.8,
TC-99M DTPA AEROSOL,5040031,CDM,343,RC,A9567,HCPCS,Outpatient,,,308,154,,82.73,26.86,,,percent of total billed charges,26.86% of total billed charges,231,75,,,percent of total billed charges,75% of total billed charges ,231,75,,,percent of total billed charges,75% of total billed charges ,73.92,24,,,percent of total billed charges,24% of total billed charges ,231,75,,,percent of total billed charges,75% of total billed charges ,231,75,,,percent of total billed charges,75% of total billed charges ,246.4,80,,,percent of total billed charges,80% of total billed charges ,74.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,155.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,231,75,,,percent of total billed charges,75% of total billed charges ,75.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,82.73,26.86,,,percent of total billed charges,26.86% of total billed charges,73.92,24,,,percent of total billed charges,24% of total billed charges ,96.1,31.2,,,percent of total billed charges,31.2% of total billed charges,246.4,80,,,percent of total billed charges,80% of total billed charges,73.92,24,,,percent of total billed charges,24% of total billed charges ,73.92,24,,,percent of total billed charges,24% of total billed charges ,73.92,246.4,
TC-99M MAA,5040032,CDM,343,RC,A9540,HCPCS,Outpatient,,,217.5,108.75,,58.42,26.86,,,percent of total billed charges,26.86% of total billed charges,163.13,75,,,percent of total billed charges,75% of total billed charges ,163.13,75,,,percent of total billed charges,75% of total billed charges ,52.2,24,,,percent of total billed charges,24% of total billed charges ,163.13,75,,,percent of total billed charges,75% of total billed charges ,163.13,75,,,percent of total billed charges,75% of total billed charges ,174,80,,,percent of total billed charges,80% of total billed charges ,52.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,109.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,163.13,75,,,percent of total billed charges,75% of total billed charges ,53.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,58.42,26.86,,,percent of total billed charges,26.86% of total billed charges,52.2,24,,,percent of total billed charges,24% of total billed charges ,67.86,31.2,,,percent of total billed charges,31.2% of total billed charges,174,80,,,percent of total billed charges,80% of total billed charges,52.2,24,,,percent of total billed charges,24% of total billed charges ,52.2,24,,,percent of total billed charges,24% of total billed charges ,52.2,174,
TC-99M SULFUR COLLOID,5040033,CDM,343,RC,A9541,HCPCS,Outpatient,,,525.5,262.75,,141.15,26.86,,,percent of total billed charges,26.86% of total billed charges,394.13,75,,,percent of total billed charges,75% of total billed charges ,394.13,75,,,percent of total billed charges,75% of total billed charges ,126.12,24,,,percent of total billed charges,24% of total billed charges ,394.13,75,,,percent of total billed charges,75% of total billed charges ,394.13,75,,,percent of total billed charges,75% of total billed charges ,420.4,80,,,percent of total billed charges,80% of total billed charges ,127.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,264.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,394.13,75,,,percent of total billed charges,75% of total billed charges ,128.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,141.15,26.86,,,percent of total billed charges,26.86% of total billed charges,126.12,24,,,percent of total billed charges,24% of total billed charges ,163.96,31.2,,,percent of total billed charges,31.2% of total billed charges,420.4,80,,,percent of total billed charges,80% of total billed charges,126.12,24,,,percent of total billed charges,24% of total billed charges ,126.12,24,,,percent of total billed charges,24% of total billed charges ,126.12,420.4,
TC-99M LABELED RBC,5040034,CDM,343,RC,A9560,HCPCS,Outpatient,,,806.5,403.25,,216.63,26.86,,,percent of total billed charges,26.86% of total billed charges,604.88,75,,,percent of total billed charges,75% of total billed charges ,604.88,75,,,percent of total billed charges,75% of total billed charges ,193.56,24,,,percent of total billed charges,24% of total billed charges ,604.88,75,,,percent of total billed charges,75% of total billed charges ,604.88,75,,,percent of total billed charges,75% of total billed charges ,645.2,80,,,percent of total billed charges,80% of total billed charges ,195.5,24.24,,,percent of total billed charges,24.24% of total billed charges ,406.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,604.88,75,,,percent of total billed charges,75% of total billed charges ,197.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,216.63,26.86,,,percent of total billed charges,26.86% of total billed charges,193.56,24,,,percent of total billed charges,24% of total billed charges ,251.63,31.2,,,percent of total billed charges,31.2% of total billed charges,645.2,80,,,percent of total billed charges,80% of total billed charges,193.56,24,,,percent of total billed charges,24% of total billed charges ,193.56,24,,,percent of total billed charges,24% of total billed charges ,193.56,645.2,
TC-99M MAG-3,5040035,CDM,343,RC,A9562,HCPCS,Outpatient,,,1559.5,779.75,,418.88,26.86,,,percent of total billed charges,26.86% of total billed charges,1169.63,75,,,percent of total billed charges,75% of total billed charges ,1169.63,75,,,percent of total billed charges,75% of total billed charges ,374.28,24,,,percent of total billed charges,24% of total billed charges ,1169.63,75,,,percent of total billed charges,75% of total billed charges ,1169.63,75,,,percent of total billed charges,75% of total billed charges ,1247.6,80,,,percent of total billed charges,80% of total billed charges ,378.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,785.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,1169.63,75,,,percent of total billed charges,75% of total billed charges ,381.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,418.88,26.86,,,percent of total billed charges,26.86% of total billed charges,374.28,24,,,percent of total billed charges,24% of total billed charges ,486.56,31.2,,,percent of total billed charges,31.2% of total billed charges,1247.6,80,,,percent of total billed charges,80% of total billed charges,374.28,24,,,percent of total billed charges,24% of total billed charges ,374.28,24,,,percent of total billed charges,24% of total billed charges ,374.28,1247.6,
NM PARATHYROID,5040036,CDM,341,RC,78070,HCPCS,Outpatient,,,1596.5,798.25,,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,1277.2,80,,,percent of total billed charges,80% of total billed charges ,386.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,804.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,1197.38,75,,,percent of total billed charges,75% of total billed charges ,390.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,428.82,26.86,,,percent of total billed charges,26.86% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,498.11,31.2,,,percent of total billed charges,31.2% of total billed charges,1277.2,80,,,percent of total billed charges,80% of total billed charges,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,24,,,percent of total billed charges,24% of total billed charges ,383.16,1277.2,
ZZZMAG SULFATE/D5W IVPB  1GM/100ML,7000021,CDM,258,RC,,,Outpatient,,,64,32,,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,51.2,
ATARAX (HYDROXYZINE HCL) 10MG TAB,7000053,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ALPHAGAN (BRIMONIDINE) OPH SOLN 0.15%,7000054,CDM,250,RC,,,Outpatient,,,752.55,376.28,,202.13,26.86,,,percent of total billed charges,26.86% of total billed charges,564.41,75,,,percent of total billed charges,75% of total billed charges ,564.41,75,,,percent of total billed charges,75% of total billed charges ,180.61,24,,,percent of total billed charges,24% of total billed charges ,564.41,75,,,percent of total billed charges,75% of total billed charges ,564.41,75,,,percent of total billed charges,75% of total billed charges ,602.04,80,,,percent of total billed charges,80% of total billed charges ,182.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,379.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,564.41,75,,,percent of total billed charges,75% of total billed charges ,184.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,202.13,26.86,,,percent of total billed charges,26.86% of total billed charges,180.61,24,,,percent of total billed charges,24% of total billed charges ,234.8,31.2,,,percent of total billed charges,31.2% of total billed charges,602.04,80,,,percent of total billed charges,80% of total billed charges,180.61,24,,,percent of total billed charges,24% of total billed charges ,180.61,24,,,percent of total billed charges,24% of total billed charges ,180.61,602.04,
ZZZAMKICAR (AMINOCAPROIC ACID) 500MG TAB,7000055,CDM,250,RC,,,Outpatient,,,130,65,,34.92,26.86,,,percent of total billed charges,26.86% of total billed charges,97.5,75,,,percent of total billed charges,75% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,104,80,,,percent of total billed charges,80% of total billed charges ,31.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,65.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,34.92,26.86,,,percent of total billed charges,26.86% of total billed charges,31.2,24,,,percent of total billed charges,24% of total billed charges ,40.56,31.2,,,percent of total billed charges,31.2% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,31.2,24,,,percent of total billed charges,24% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,31.2,104,
HYDROCOD/CHLORPHEN (TUSSIONEX)  5ML,7000060,CDM,250,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
NF-ULORIC ORAL TABLET 40MG,7000061,CDM,250,RC,,,Outpatient,,,26,13,,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,20.8,
NORMAL SALINE FLUSH 3ML SYRINGE,7000062,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
NF-DAPSONE,7000063,CDM,250,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
"ZZZNF-2,3 DIMERCAPTOSUCCINIC ACID POWDER",7000064,CDM,250,RC,,,Outpatient,,,49.5,24.75,,13.3,26.86,,,percent of total billed charges,26.86% of total billed charges,37.13,75,,,percent of total billed charges,75% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,11.88,24,,,percent of total billed charges,24% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,39.6,80,,,percent of total billed charges,80% of total billed charges ,12,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,12.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.3,26.86,,,percent of total billed charges,26.86% of total billed charges,11.88,24,,,percent of total billed charges,24% of total billed charges ,15.44,31.2,,,percent of total billed charges,31.2% of total billed charges,39.6,80,,,percent of total billed charges,80% of total billed charges,11.88,24,,,percent of total billed charges,24% of total billed charges ,11.88,24,,,percent of total billed charges,24% of total billed charges ,11.88,39.6,
NF-TARCEVA TAB 150MG,7000065,CDM,250,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
NF-TASIGNA CAP 150MG,7000066,CDM,250,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
D5W 1000 ML,7000069,CDM,636,RC,J7060,HCPCS,Outpatient,,,64,32,,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,1.93,51.2,
ZZZFLUZONE (INFLUENZE VACCINE) 0.5ML,7000070,CDM,250,RC,90656,HCPCS,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
METRONIDAZOLE/NS 500MG/100ML PREMIX,7000073,CDM,258,RC,,,Outpatient,,,42,21,,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,33.6,80,,,percent of total billed charges,80% of total billed charges ,10.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,13.1,31.2,,,percent of total billed charges,31.2% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,33.6,
SODIUM CHLORIDE 3000ML IRRIGATION,7000074,CDM,272,RC,,,Outpatient,,,106.5,53.25,,28.61,26.86,,,percent of total billed charges,26.86% of total billed charges,79.88,75,,,percent of total billed charges,75% of total billed charges ,79.88,75,,,percent of total billed charges,75% of total billed charges ,25.56,24,,,percent of total billed charges,24% of total billed charges ,79.88,75,,,percent of total billed charges,75% of total billed charges ,79.88,75,,,percent of total billed charges,75% of total billed charges ,85.2,80,,,percent of total billed charges,80% of total billed charges ,25.82,24.24,,,percent of total billed charges,24.24% of total billed charges ,53.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,79.88,75,,,percent of total billed charges,75% of total billed charges ,26.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.61,26.86,,,percent of total billed charges,26.86% of total billed charges,25.56,24,,,percent of total billed charges,24% of total billed charges ,33.23,31.2,,,percent of total billed charges,31.2% of total billed charges,85.2,80,,,percent of total billed charges,80% of total billed charges,25.56,24,,,percent of total billed charges,24% of total billed charges ,25.56,24,,,percent of total billed charges,24% of total billed charges ,25.56,85.2,
NS (0.9% SODIUM CHLORIDE) 10ML VIAL,7000075,CDM,259,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ALBUTEROL (ACCUNEB) 1.25MG/3ML UD,7000076,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZFLUZONE HI-DOSE (INFLUENZA)0.5ML,7000077,CDM,636,RC,90662,HCPCS,Outpatient,,,83.5,41.75,,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,73.4,
ZZZBETAMETHASONE SOD PH (CELESTONE) 30MG,7000078,CDM,250,RC,,,Outpatient,,,302,151,,81.12,26.86,,,percent of total billed charges,26.86% of total billed charges,226.5,75,,,percent of total billed charges,75% of total billed charges ,226.5,75,,,percent of total billed charges,75% of total billed charges ,72.48,24,,,percent of total billed charges,24% of total billed charges ,226.5,75,,,percent of total billed charges,75% of total billed charges ,226.5,75,,,percent of total billed charges,75% of total billed charges ,241.6,80,,,percent of total billed charges,80% of total billed charges ,73.2,24.24,,,percent of total billed charges,24.24% of total billed charges ,152.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,226.5,75,,,percent of total billed charges,75% of total billed charges ,73.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,81.12,26.86,,,percent of total billed charges,26.86% of total billed charges,72.48,24,,,percent of total billed charges,24% of total billed charges ,94.22,31.2,,,percent of total billed charges,31.2% of total billed charges,241.6,80,,,percent of total billed charges,80% of total billed charges,72.48,24,,,percent of total billed charges,24% of total billed charges ,72.48,24,,,percent of total billed charges,24% of total billed charges ,72.48,241.6,
LEVOTHYROXINE SOD (SYNTHROID) 100MCG INJ,7000079,CDM,250,RC,,,Outpatient,,,539.5,269.75,,144.91,26.86,,,percent of total billed charges,26.86% of total billed charges,404.63,75,,,percent of total billed charges,75% of total billed charges ,404.63,75,,,percent of total billed charges,75% of total billed charges ,129.48,24,,,percent of total billed charges,24% of total billed charges ,404.63,75,,,percent of total billed charges,75% of total billed charges ,404.63,75,,,percent of total billed charges,75% of total billed charges ,431.6,80,,,percent of total billed charges,80% of total billed charges ,130.77,24.24,,,percent of total billed charges,24.24% of total billed charges ,271.91,50.4,,,percent of total billed charges,50.4% of total billed charges ,404.63,75,,,percent of total billed charges,75% of total billed charges ,132.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,144.91,26.86,,,percent of total billed charges,26.86% of total billed charges,129.48,24,,,percent of total billed charges,24% of total billed charges ,168.32,31.2,,,percent of total billed charges,31.2% of total billed charges,431.6,80,,,percent of total billed charges,80% of total billed charges,129.48,24,,,percent of total billed charges,24% of total billed charges ,129.48,24,,,percent of total billed charges,24% of total billed charges ,129.48,431.6,
NF-STRIBILD ORAL TABLET,7000080,CDM,250,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
SULFA/TRIMETH (SEPTRA) 800MG/160MG INJ,7000081,CDM,250,RC,,,Outpatient,,,83.5,41.75,,22.43,26.86,,,percent of total billed charges,26.86% of total billed charges,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.43,26.86,,,percent of total billed charges,26.86% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,66.8,
MIDAZOLAM (VERSED) 5MG/ML INJ,7000083,CDM,636,RC,J2250,HCPCS,Outpatient,,,30,15,,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24,80,,,percent of total billed charges,80% of total billed charges ,7.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.2,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,,,percent of total billed charges,31.2% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,0.14,24,
GLYCOPYRROLATE (ROBINUL) 0.2MG/ML INJ,7000084,CDM,250,RC,,,Outpatient,,,59.5,29.75,,15.98,26.86,,,percent of total billed charges,26.86% of total billed charges,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.98,26.86,,,percent of total billed charges,26.86% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,47.6,
NF-XARELTO ORAL TABLET 15MG,7000085,CDM,250,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
NF-XARELTO ORAL TABLET 15MG,7000086,CDM,250,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
NF-XARELTO ORAL TABLET 10MG,7000087,CDM,250,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
NF-SYSTANE OPHTH SOLUTION,7000089,CDM,250,RC,,,Outpatient,,,2,1,,0.54,26.86,,,percent of total billed charges,26.86% of total billed charges,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,0.48,24,,,percent of total billed charges,24% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.6,80,,,percent of total billed charges,80% of total billed charges ,0.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,1.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,0.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.54,26.86,,,percent of total billed charges,26.86% of total billed charges,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.62,31.2,,,percent of total billed charges,31.2% of total billed charges,1.6,80,,,percent of total billed charges,80% of total billed charges,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.48,1.6,
NF-COQ10 IN OIL LIQUID CAPSULE 100MG-30I,7000090,CDM,250,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
NF-TRI-SPRINTEC 28 ORAL TABLET,7000091,CDM,250,RC,,,Outpatient,,,4,2,,1.07,26.86,,,percent of total billed charges,26.86% of total billed charges,3,75,,,percent of total billed charges,75% of total billed charges ,3,75,,,percent of total billed charges,75% of total billed charges ,0.96,24,,,percent of total billed charges,24% of total billed charges ,3,75,,,percent of total billed charges,75% of total billed charges ,3,75,,,percent of total billed charges,75% of total billed charges ,3.2,80,,,percent of total billed charges,80% of total billed charges ,0.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,2.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,3,75,,,percent of total billed charges,75% of total billed charges ,0.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.07,26.86,,,percent of total billed charges,26.86% of total billed charges,0.96,24,,,percent of total billed charges,24% of total billed charges ,1.25,31.2,,,percent of total billed charges,31.2% of total billed charges,3.2,80,,,percent of total billed charges,80% of total billed charges,0.96,24,,,percent of total billed charges,24% of total billed charges ,0.96,24,,,percent of total billed charges,24% of total billed charges ,0.96,3.2,
NF-BIOTIN ORAL TABLET 1000MCG,7000092,CDM,250,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
GLYCOPYRROLATE (ROBINUL) 0.2MG/ML INJ,7000094,CDM,259,RC,,,Outpatient,,,11.63,5.82,,3.12,26.86,,,percent of total billed charges,26.86% of total billed charges,8.72,75,,,percent of total billed charges,75% of total billed charges ,8.72,75,,,percent of total billed charges,75% of total billed charges ,2.79,24,,,percent of total billed charges,24% of total billed charges ,8.72,75,,,percent of total billed charges,75% of total billed charges ,8.72,75,,,percent of total billed charges,75% of total billed charges ,9.3,80,,,percent of total billed charges,80% of total billed charges ,2.82,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,8.72,75,,,percent of total billed charges,75% of total billed charges ,2.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.12,26.86,,,percent of total billed charges,26.86% of total billed charges,2.79,24,,,percent of total billed charges,24% of total billed charges ,3.63,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,2.79,24,,,percent of total billed charges,24% of total billed charges ,2.79,24,,,percent of total billed charges,24% of total billed charges ,2.79,9.3,
ZZZGLYCOPYRROLATE (ROBINUL) 0.2MG/ML INJ,7000095,CDM,250,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
GLYCOPYRROLATE (ROBINUL) 0.2MG/ML INJ,7000096,CDM,259,RC,,,Outpatient,,,11.63,5.82,,3.12,26.86,,,percent of total billed charges,26.86% of total billed charges,8.72,75,,,percent of total billed charges,75% of total billed charges ,8.72,75,,,percent of total billed charges,75% of total billed charges ,2.79,24,,,percent of total billed charges,24% of total billed charges ,8.72,75,,,percent of total billed charges,75% of total billed charges ,8.72,75,,,percent of total billed charges,75% of total billed charges ,9.3,80,,,percent of total billed charges,80% of total billed charges ,2.82,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,8.72,75,,,percent of total billed charges,75% of total billed charges ,2.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.12,26.86,,,percent of total billed charges,26.86% of total billed charges,2.79,24,,,percent of total billed charges,24% of total billed charges ,3.63,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,2.79,24,,,percent of total billed charges,24% of total billed charges ,2.79,24,,,percent of total billed charges,24% of total billed charges ,2.79,9.3,
GLYCOPYRROLATE (ROBINUL) 0.2MG/ML INJ,7000097,CDM,259,RC,,,Outpatient,,,11.63,5.82,,3.12,26.86,,,percent of total billed charges,26.86% of total billed charges,8.72,75,,,percent of total billed charges,75% of total billed charges ,8.72,75,,,percent of total billed charges,75% of total billed charges ,2.79,24,,,percent of total billed charges,24% of total billed charges ,8.72,75,,,percent of total billed charges,75% of total billed charges ,8.72,75,,,percent of total billed charges,75% of total billed charges ,9.3,80,,,percent of total billed charges,80% of total billed charges ,2.82,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,8.72,75,,,percent of total billed charges,75% of total billed charges ,2.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.12,26.86,,,percent of total billed charges,26.86% of total billed charges,2.79,24,,,percent of total billed charges,24% of total billed charges ,3.63,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,2.79,24,,,percent of total billed charges,24% of total billed charges ,2.79,24,,,percent of total billed charges,24% of total billed charges ,2.79,9.3,
GLYCOPYRROLATE (ROBINUL) 0.2MG/ML INJ,7000098,CDM,259,RC,,,Outpatient,,,11.63,5.82,,3.12,26.86,,,percent of total billed charges,26.86% of total billed charges,8.72,75,,,percent of total billed charges,75% of total billed charges ,8.72,75,,,percent of total billed charges,75% of total billed charges ,2.79,24,,,percent of total billed charges,24% of total billed charges ,8.72,75,,,percent of total billed charges,75% of total billed charges ,8.72,75,,,percent of total billed charges,75% of total billed charges ,9.3,80,,,percent of total billed charges,80% of total billed charges ,2.82,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,8.72,75,,,percent of total billed charges,75% of total billed charges ,2.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.12,26.86,,,percent of total billed charges,26.86% of total billed charges,2.79,24,,,percent of total billed charges,24% of total billed charges ,3.63,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,2.79,24,,,percent of total billed charges,24% of total billed charges ,2.79,24,,,percent of total billed charges,24% of total billed charges ,2.79,9.3,
FENTANYL 250MCG/5ML INJ,7000099,CDM,636,RC,J3010,HCPCS,Outpatient,,,29,14.5,,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.2,80,,,percent of total billed charges,80% of total billed charges ,7.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,7.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.96,24,,,percent of total billed charges,24% of total billed charges ,9.05,31.2,,,percent of total billed charges,31.2% of total billed charges,23.2,80,,,percent of total billed charges,80% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,0.97,23.2,
NF-GENGRAF CAPSULE 100MG,7000100,CDM,250,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
NF-ZESTORETIC ORAL TABLET 20MG-12.5MG,7000101,CDM,250,RC,,,Outpatient,,,6,3,,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.8,80,,,percent of total billed charges,80% of total billed charges ,1.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.87,31.2,,,percent of total billed charges,31.2% of total billed charges,4.8,80,,,percent of total billed charges,80% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,4.8,
NF-OMEPRAZOLE CAP DR 10MG,7000102,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
NF-XARELTO ORAL TABLET 20MG,7000103,CDM,250,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
ZZZNF-12 HOUR DECONGEORAL TAB ER 120M,7000105,CDM,250,RC,,,Outpatient,,,1,0.5,,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.8,80,,,percent of total billed charges,80% of total billed charges ,0.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,0.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.31,31.2,,,percent of total billed charges,31.2% of total billed charges,0.8,80,,,percent of total billed charges,80% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,0.8,
NF-TARCEVA ORAL TABLET 150MG,7000106,CDM,250,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
NF-RANITIDINE HCL CAP 150MG,7000107,CDM,250,RC,,,Outpatient,,,5,2.5,,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,4,80,,,percent of total billed charges,80% of total billed charges ,1.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,2.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.56,31.2,,,percent of total billed charges,31.2% of total billed charges,4,80,,,percent of total billed charges,80% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,4,
NF-RESTASIS OPHTH EMULSION 0.05%,7000109,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
"NF-VITAMIN D CAPSULE 50,000IU",7000110,CDM,250,RC,,,Outpatient,,,1,0.5,,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.8,80,,,percent of total billed charges,80% of total billed charges ,0.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,0.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.31,31.2,,,percent of total billed charges,31.2% of total billed charges,0.8,80,,,percent of total billed charges,80% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,0.8,
NF-PERCOCET TAB 325MG-5MG,7000111,CDM,250,RC,,,Outpatient,,,2,1,,0.54,26.86,,,percent of total billed charges,26.86% of total billed charges,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,0.48,24,,,percent of total billed charges,24% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.6,80,,,percent of total billed charges,80% of total billed charges ,0.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,1.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,0.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.54,26.86,,,percent of total billed charges,26.86% of total billed charges,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.62,31.2,,,percent of total billed charges,31.2% of total billed charges,1.6,80,,,percent of total billed charges,80% of total billed charges,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.48,1.6,
ZZZNF- FELODIPINE TABLET ER 5MG,7000112,CDM,250,RC,,,Outpatient,,,5,2.5,,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,4,80,,,percent of total billed charges,80% of total billed charges ,1.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,2.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.56,31.2,,,percent of total billed charges,31.2% of total billed charges,4,80,,,percent of total billed charges,80% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,4,
NF-FEMARA TAB 2.5MG,7000113,CDM,250,RC,,,Outpatient,,,57.5,28.75,,15.44,26.86,,,percent of total billed charges,26.86% of total billed charges,43.13,75,,,percent of total billed charges,75% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,13.8,24,,,percent of total billed charges,24% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,46,80,,,percent of total billed charges,80% of total billed charges ,13.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,14.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.44,26.86,,,percent of total billed charges,26.86% of total billed charges,13.8,24,,,percent of total billed charges,24% of total billed charges ,17.94,31.2,,,percent of total billed charges,31.2% of total billed charges,46,80,,,percent of total billed charges,80% of total billed charges,13.8,24,,,percent of total billed charges,24% of total billed charges ,13.8,24,,,percent of total billed charges,24% of total billed charges ,13.8,46,
NF-SAPHRIS SL TAB 10MG,7000115,CDM,250,RC,,,Outpatient,,,44.5,22.25,,11.95,26.86,,,percent of total billed charges,26.86% of total billed charges,33.38,75,,,percent of total billed charges,75% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,10.68,24,,,percent of total billed charges,24% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,35.6,80,,,percent of total billed charges,80% of total billed charges ,10.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,10.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.95,26.86,,,percent of total billed charges,26.86% of total billed charges,10.68,24,,,percent of total billed charges,24% of total billed charges ,13.88,31.2,,,percent of total billed charges,31.2% of total billed charges,35.6,80,,,percent of total billed charges,80% of total billed charges,10.68,24,,,percent of total billed charges,24% of total billed charges ,10.68,24,,,percent of total billed charges,24% of total billed charges ,10.68,35.6,
NF-SYMBICORT INH AER LIQ 80MCG-4.5MCG,7000116,CDM,250,RC,,,Outpatient,,,77.5,38.75,,20.82,26.86,,,percent of total billed charges,26.86% of total billed charges,58.13,75,,,percent of total billed charges,75% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,18.6,24,,,percent of total billed charges,24% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,62,80,,,percent of total billed charges,80% of total billed charges ,18.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,18.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.82,26.86,,,percent of total billed charges,26.86% of total billed charges,18.6,24,,,percent of total billed charges,24% of total billed charges ,24.18,31.2,,,percent of total billed charges,31.2% of total billed charges,62,80,,,percent of total billed charges,80% of total billed charges,18.6,24,,,percent of total billed charges,24% of total billed charges ,18.6,24,,,percent of total billed charges,24% of total billed charges ,18.6,62,
NF-BUTRANS TD PATCH ER 5MCG/1HR,7000117,CDM,250,RC,,,Outpatient,,,140,70,,37.6,26.86,,,percent of total billed charges,26.86% of total billed charges,105,75,,,percent of total billed charges,75% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,33.6,24,,,percent of total billed charges,24% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,112,80,,,percent of total billed charges,80% of total billed charges ,33.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,70.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,105,75,,,percent of total billed charges,75% of total billed charges ,34.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.6,26.86,,,percent of total billed charges,26.86% of total billed charges,33.6,24,,,percent of total billed charges,24% of total billed charges ,43.68,31.2,,,percent of total billed charges,31.2% of total billed charges,112,80,,,percent of total billed charges,80% of total billed charges,33.6,24,,,percent of total billed charges,24% of total billed charges ,33.6,24,,,percent of total billed charges,24% of total billed charges ,33.6,112,
NF-TRICOR ORAL TABLET 48MG,7000118,CDM,250,RC,,,Outpatient,,,7,3.5,,1.88,26.86,,,percent of total billed charges,26.86% of total billed charges,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.6,80,,,percent of total billed charges,80% of total billed charges ,1.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,1.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.88,26.86,,,percent of total billed charges,26.86% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,2.18,31.2,,,percent of total billed charges,31.2% of total billed charges,5.6,80,,,percent of total billed charges,80% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,5.6,
NF-NEXAVAR ORAL TABLET 200MG,7000119,CDM,250,RC,,,Outpatient,,,312,156,,83.8,26.86,,,percent of total billed charges,26.86% of total billed charges,234,75,,,percent of total billed charges,75% of total billed charges ,234,75,,,percent of total billed charges,75% of total billed charges ,74.88,24,,,percent of total billed charges,24% of total billed charges ,234,75,,,percent of total billed charges,75% of total billed charges ,234,75,,,percent of total billed charges,75% of total billed charges ,249.6,80,,,percent of total billed charges,80% of total billed charges ,75.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,157.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,234,75,,,percent of total billed charges,75% of total billed charges ,76.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,83.8,26.86,,,percent of total billed charges,26.86% of total billed charges,74.88,24,,,percent of total billed charges,24% of total billed charges ,97.34,31.2,,,percent of total billed charges,31.2% of total billed charges,249.6,80,,,percent of total billed charges,80% of total billed charges,74.88,24,,,percent of total billed charges,24% of total billed charges ,74.88,24,,,percent of total billed charges,24% of total billed charges ,74.88,249.6,
NF-LIVALO TAB 2MG,7000120,CDM,250,RC,,,Outpatient,,,17.5,8.75,,4.7,26.86,,,percent of total billed charges,26.86% of total billed charges,13.13,75,,,percent of total billed charges,75% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,4.2,24,,,percent of total billed charges,24% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,14,80,,,percent of total billed charges,80% of total billed charges ,4.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,4.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.7,26.86,,,percent of total billed charges,26.86% of total billed charges,4.2,24,,,percent of total billed charges,24% of total billed charges ,5.46,31.2,,,percent of total billed charges,31.2% of total billed charges,14,80,,,percent of total billed charges,80% of total billed charges,4.2,24,,,percent of total billed charges,24% of total billed charges ,4.2,24,,,percent of total billed charges,24% of total billed charges ,4.2,14,
ZZZBENEPROTEIN PROTEIN POWDER 227GM,7000121,CDM,250,RC,,,Outpatient,,,227.5,113.75,,61.11,26.86,,,percent of total billed charges,26.86% of total billed charges,170.63,75,,,percent of total billed charges,75% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,54.6,24,,,percent of total billed charges,24% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,182,80,,,percent of total billed charges,80% of total billed charges ,55.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,114.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,170.63,75,,,percent of total billed charges,75% of total billed charges ,55.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,61.11,26.86,,,percent of total billed charges,26.86% of total billed charges,54.6,24,,,percent of total billed charges,24% of total billed charges ,70.98,31.2,,,percent of total billed charges,31.2% of total billed charges,182,80,,,percent of total billed charges,80% of total billed charges,54.6,24,,,percent of total billed charges,24% of total billed charges ,54.6,24,,,percent of total billed charges,24% of total billed charges ,54.6,182,
TIMOLOL MAL (TIMOPTIC)O 0.25% O.S. 5ML,7000122,CDM,259,RC,,,Outpatient,,,53.5,26.75,,14.37,26.86,,,percent of total billed charges,26.86% of total billed charges,40.13,75,,,percent of total billed charges,75% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,42.8,80,,,percent of total billed charges,80% of total billed charges ,12.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,13.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.37,26.86,,,percent of total billed charges,26.86% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,16.69,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,42.8,
ZZZJANUVIA (SITAGLIPTIN) 25MG TAB,7000124,CDM,259,RC,,,Outpatient,,,81.5,40.75,,21.89,26.86,,,percent of total billed charges,26.86% of total billed charges,61.13,75,,,percent of total billed charges,75% of total billed charges ,61.13,75,,,percent of total billed charges,75% of total billed charges ,19.56,24,,,percent of total billed charges,24% of total billed charges ,61.13,75,,,percent of total billed charges,75% of total billed charges ,61.13,75,,,percent of total billed charges,75% of total billed charges ,65.2,80,,,percent of total billed charges,80% of total billed charges ,19.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.13,75,,,percent of total billed charges,75% of total billed charges ,19.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.89,26.86,,,percent of total billed charges,26.86% of total billed charges,19.56,24,,,percent of total billed charges,24% of total billed charges ,25.43,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,19.56,24,,,percent of total billed charges,24% of total billed charges ,19.56,24,,,percent of total billed charges,24% of total billed charges ,19.56,65.2,
ZZZTAMBOCOR (FLECAINIDE) 100MG TAB,7000126,CDM,259,RC,,,Outpatient,,,28,14,,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,22.4,80,,,percent of total billed charges,80% of total billed charges ,6.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,8.74,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,22.4,
ZZZMOBIC (MELOXICAM) 15MG TAB,7000128,CDM,250,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
ZZZNF- KETOROLAC TROMETHAMINE 30MG/1ML,7000130,CDM,250,RC,,,Outpatient,,,2,1,,0.54,26.86,,,percent of total billed charges,26.86% of total billed charges,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,0.48,24,,,percent of total billed charges,24% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.6,80,,,percent of total billed charges,80% of total billed charges ,0.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,1.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,0.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.54,26.86,,,percent of total billed charges,26.86% of total billed charges,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.62,31.2,,,percent of total billed charges,31.2% of total billed charges,1.6,80,,,percent of total billed charges,80% of total billed charges,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.48,1.6,
DESITIN (ZINC OXIDE) PASTE,7000131,CDM,250,RC,,,Outpatient,,,26,13,,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,20.8,
NF-DEPAKOTE DELAYED-RELEASE TABLET 125MG,7000132,CDM,250,RC,,,Outpatient,,,2,1,,0.54,26.86,,,percent of total billed charges,26.86% of total billed charges,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,0.48,24,,,percent of total billed charges,24% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.6,80,,,percent of total billed charges,80% of total billed charges ,0.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,1.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,0.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.54,26.86,,,percent of total billed charges,26.86% of total billed charges,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.62,31.2,,,percent of total billed charges,31.2% of total billed charges,1.6,80,,,percent of total billed charges,80% of total billed charges,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.48,1.6,
NF-ASACOL HD TAB DR 800MG,7000133,CDM,250,RC,,,Outpatient,,,13.5,6.75,,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.8,80,,,percent of total billed charges,80% of total billed charges ,3.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,4.21,31.2,,,percent of total billed charges,31.2% of total billed charges,10.8,80,,,percent of total billed charges,80% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,10.8,
NF-PROAIR HFA AER PWD 0.09MG/1ACT,7000134,CDM,250,RC,,,Outpatient,,,13.5,6.75,,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.8,80,,,percent of total billed charges,80% of total billed charges ,3.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,4.21,31.2,,,percent of total billed charges,31.2% of total billed charges,10.8,80,,,percent of total billed charges,80% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,10.8,
NF-NAMENDA XR CAP ER 28MG,7000135,CDM,250,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
ZZZPRAVACHOL (PRAVASTATIN) 10MG TAB,7000136,CDM,250,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
NF-ESTROGEL TD GEL 0.06%,7000139,CDM,250,RC,,,Outpatient,,,3,1.5,,0.81,26.86,,,percent of total billed charges,26.86% of total billed charges,2.25,75,,,percent of total billed charges,75% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,0.72,24,,,percent of total billed charges,24% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,2.4,80,,,percent of total billed charges,80% of total billed charges ,0.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,1.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,0.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.81,26.86,,,percent of total billed charges,26.86% of total billed charges,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.94,31.2,,,percent of total billed charges,31.2% of total billed charges,2.4,80,,,percent of total billed charges,80% of total billed charges,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.72,2.4,
ZZZANCEF (CEFAZOLIN) 2 GM /D5W  50ML,7000140,CDM,636,RC,J0690,HCPCS,Outpatient,,,85.5,42.75,,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.4,80,,,percent of total billed charges,80% of total billed charges ,20.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,43.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,20.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.52,24,,,percent of total billed charges,24% of total billed charges ,26.68,31.2,,,percent of total billed charges,31.2% of total billed charges,68.4,80,,,percent of total billed charges,80% of total billed charges,20.52,24,,,percent of total billed charges,24% of total billed charges ,20.52,24,,,percent of total billed charges,24% of total billed charges ,0.76,68.4,
NF-POLYTRIM OPHTH SOLUTION,7000141,CDM,250,RC,,,Outpatient,,,13.5,6.75,,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.8,80,,,percent of total billed charges,80% of total billed charges ,3.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,4.21,31.2,,,percent of total billed charges,31.2% of total billed charges,10.8,80,,,percent of total billed charges,80% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,10.8,
NF-VISINE A.C. OPHTH SOLUTION 0.05%-0.25,7000142,CDM,250,RC,,,Outpatient,,,1,0.5,,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.8,80,,,percent of total billed charges,80% of total billed charges ,0.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,0.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.31,31.2,,,percent of total billed charges,31.2% of total billed charges,0.8,80,,,percent of total billed charges,80% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,0.8,
ZZZNF- ALTAVERA TAB 30MCG-0.15MG-NA,7000143,CDM,250,RC,,,Outpatient,,,3,1.5,,0.81,26.86,,,percent of total billed charges,26.86% of total billed charges,2.25,75,,,percent of total billed charges,75% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,0.72,24,,,percent of total billed charges,24% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,2.4,80,,,percent of total billed charges,80% of total billed charges ,0.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,1.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,0.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.81,26.86,,,percent of total billed charges,26.86% of total billed charges,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.94,31.2,,,percent of total billed charges,31.2% of total billed charges,2.4,80,,,percent of total billed charges,80% of total billed charges,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.72,2.4,
NF-LEVEMIR FLEXPEN SUBQ SOLN 100U/1ML,7000144,CDM,250,RC,,,Outpatient,,,64,32,,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,51.2,
NF-LEVEMIR  SUBQ SOLN 100U/1ML,7000145,CDM,250,RC,,,Outpatient,,,56.5,28.25,,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
NF-VOLTAREN GEL TOPICAL 1%,7000146,CDM,250,RC,,,Outpatient,,,2,1,,0.54,26.86,,,percent of total billed charges,26.86% of total billed charges,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,0.48,24,,,percent of total billed charges,24% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.6,80,,,percent of total billed charges,80% of total billed charges ,0.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,1.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,0.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.54,26.86,,,percent of total billed charges,26.86% of total billed charges,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.62,31.2,,,percent of total billed charges,31.2% of total billed charges,1.6,80,,,percent of total billed charges,80% of total billed charges,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.48,1.6,
ZZZNF-ADVAIR HFA INH 230MCG-30.45MCG/1,7000148,CDM,250,RC,,,Outpatient,,,112.5,56.25,,30.22,26.86,,,percent of total billed charges,26.86% of total billed charges,84.38,75,,,percent of total billed charges,75% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,27,24,,,percent of total billed charges,24% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,90,80,,,percent of total billed charges,80% of total billed charges ,27.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,56.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,27.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.22,26.86,,,percent of total billed charges,26.86% of total billed charges,27,24,,,percent of total billed charges,24% of total billed charges ,35.1,31.2,,,percent of total billed charges,31.2% of total billed charges,90,80,,,percent of total billed charges,80% of total billed charges,27,24,,,percent of total billed charges,24% of total billed charges ,27,24,,,percent of total billed charges,24% of total billed charges ,27,90,
NF-PREMPRO ORAL TABLET 0.3MG-1.5MG,7000149,CDM,250,RC,,,Outpatient,,,13.5,6.75,,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.8,80,,,percent of total billed charges,80% of total billed charges ,3.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,4.21,31.2,,,percent of total billed charges,31.2% of total billed charges,10.8,80,,,percent of total billed charges,80% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,10.8,
NF-PROTONIX ORAL TAB EC 40MG,7000152,CDM,250,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
NF-PENTASA CAP ER 500MG,7000154,CDM,250,RC,,,Outpatient,,,7,3.5,,1.88,26.86,,,percent of total billed charges,26.86% of total billed charges,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.6,80,,,percent of total billed charges,80% of total billed charges ,1.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,1.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.88,26.86,,,percent of total billed charges,26.86% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,2.18,31.2,,,percent of total billed charges,31.2% of total billed charges,5.6,80,,,percent of total billed charges,80% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,5.6,
NF-COLESTID TAB 1GM,7000155,CDM,250,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
NF-CREON CAP DR,7000157,CDM,250,RC,,,Outpatient,,,6,3,,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.8,80,,,percent of total billed charges,80% of total billed charges ,1.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.87,31.2,,,percent of total billed charges,31.2% of total billed charges,4.8,80,,,percent of total billed charges,80% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,4.8,
NF-DESIPRAMINE HCL ORAL TABLET 25MG,7000158,CDM,250,RC,,,Outpatient,,,3,1.5,,0.81,26.86,,,percent of total billed charges,26.86% of total billed charges,2.25,75,,,percent of total billed charges,75% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,0.72,24,,,percent of total billed charges,24% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,2.4,80,,,percent of total billed charges,80% of total billed charges ,0.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,1.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,0.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.81,26.86,,,percent of total billed charges,26.86% of total billed charges,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.94,31.2,,,percent of total billed charges,31.2% of total billed charges,2.4,80,,,percent of total billed charges,80% of total billed charges,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.72,2.4,
ZZZMULT-DELYN LIQUID 5ML,7000160,CDM,259,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZEPSOM SALT (MAG SULF) 454GM(1LB),7000161,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ZZZEPSOM SALT (MAGNESIUM SULF) 4 LB,7000162,CDM,250,RC,,,Outpatient,,,77.5,38.75,,20.82,26.86,,,percent of total billed charges,26.86% of total billed charges,58.13,75,,,percent of total billed charges,75% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,18.6,24,,,percent of total billed charges,24% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,62,80,,,percent of total billed charges,80% of total billed charges ,18.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,18.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.82,26.86,,,percent of total billed charges,26.86% of total billed charges,18.6,24,,,percent of total billed charges,24% of total billed charges ,24.18,31.2,,,percent of total billed charges,31.2% of total billed charges,62,80,,,percent of total billed charges,80% of total billed charges,18.6,24,,,percent of total billed charges,24% of total billed charges ,18.6,24,,,percent of total billed charges,24% of total billed charges ,18.6,62,
NF-RANEXA EXTENDED-RELEASE TABLET 500MG,7000163,CDM,250,RC,,,Outpatient,,,14.51,7.26,,3.9,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.61,80,,,percent of total billed charges,80% of total billed charges ,3.52,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.9,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.53,31.2,,,percent of total billed charges,31.2% of total billed charges,11.61,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.61,
NF-DALIRESP ORAL TABLET 500MCG,7000164,CDM,250,RC,,,Outpatient,,,26,13,,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,20.8,
NF-ONGLYZA ORAL TABLET 5MG,7000166,CDM,250,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
NF-DESMOPRESSIN ACETATE NASAL SOLN 0.01%,7000167,CDM,250,RC,,,Outpatient,,,35,17.5,,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,28,80,,,percent of total billed charges,80% of total billed charges ,8.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,10.92,31.2,,,percent of total billed charges,31.2% of total billed charges,28,80,,,percent of total billed charges,80% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,28,
NF-HECTOROL CAP 1MCG,7000168,CDM,250,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
ZZZDESMOPRESSIN NASAL SPRAY SOL,7000169,CDM,250,RC,,,Outpatient,,,530.5,265.25,,142.49,26.86,,,percent of total billed charges,26.86% of total billed charges,397.88,75,,,percent of total billed charges,75% of total billed charges ,397.88,75,,,percent of total billed charges,75% of total billed charges ,127.32,24,,,percent of total billed charges,24% of total billed charges ,397.88,75,,,percent of total billed charges,75% of total billed charges ,397.88,75,,,percent of total billed charges,75% of total billed charges ,424.4,80,,,percent of total billed charges,80% of total billed charges ,128.59,24.24,,,percent of total billed charges,24.24% of total billed charges ,267.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,397.88,75,,,percent of total billed charges,75% of total billed charges ,129.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,142.49,26.86,,,percent of total billed charges,26.86% of total billed charges,127.32,24,,,percent of total billed charges,24% of total billed charges ,165.52,31.2,,,percent of total billed charges,31.2% of total billed charges,424.4,80,,,percent of total billed charges,80% of total billed charges,127.32,24,,,percent of total billed charges,24% of total billed charges ,127.32,24,,,percent of total billed charges,24% of total billed charges ,127.32,424.4,
DEXTROSE 5% INJ 500ML IVPB,7000170,CDM,636,RC,J7060,HCPCS,Outpatient,,,53.5,26.75,,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.8,80,,,percent of total billed charges,80% of total billed charges ,12.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,13.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.84,24,,,percent of total billed charges,24% of total billed charges ,16.69,31.2,,,percent of total billed charges,31.2% of total billed charges,42.8,80,,,percent of total billed charges,80% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,1.93,42.8,
DEXTROSE 5% + 0.2% SOD CHL 250ML IVPB,7000171,CDM,636,RC,J7040,HCPCS,Outpatient,,,41,20.5,,1.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.8,80,,,percent of total billed charges,80% of total billed charges ,9.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,10.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.84,24,,,percent of total billed charges,24% of total billed charges ,12.79,31.2,,,percent of total billed charges,31.2% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,1.35,32.8,
NF-OMEPRAZOLE CAP DR 20MG,7000172,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
NF-FRESHKOTE OPHTH SOLN 2.7%-2%,7000173,CDM,250,RC,,,Outpatient,,,6,3,,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.8,80,,,percent of total billed charges,80% of total billed charges ,1.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.87,31.2,,,percent of total billed charges,31.2% of total billed charges,4.8,80,,,percent of total billed charges,80% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,4.8,
NF-CANDESARTAN CILEXETIL ORAL TABLET 16M,7000175,CDM,250,RC,,,Outpatient,,,10.5,5.25,,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,8.4,80,,,percent of total billed charges,80% of total billed charges ,2.55,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,3.28,31.2,,,percent of total billed charges,31.2% of total billed charges,8.4,80,,,percent of total billed charges,80% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,8.4,
NF-DYMISTA NASAL SPRAY 137MCG-50MCG/1 AC,7000177,CDM,250,RC,,,Outpatient,,,23.5,11.75,,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,18.8,80,,,percent of total billed charges,80% of total billed charges ,5.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,7.33,31.2,,,percent of total billed charges,31.2% of total billed charges,18.8,80,,,percent of total billed charges,80% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,18.8,
NF-BONIVA ORAL TABLET 150MG,7000178,CDM,250,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
NF-DUREZOL OPHTH EMUL 0.05%,7000179,CDM,250,RC,,,Outpatient,,,106,53,,28.47,26.86,,,percent of total billed charges,26.86% of total billed charges,79.5,75,,,percent of total billed charges,75% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,25.44,24,,,percent of total billed charges,24% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,84.8,80,,,percent of total billed charges,80% of total billed charges ,25.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,53.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,25.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.47,26.86,,,percent of total billed charges,26.86% of total billed charges,25.44,24,,,percent of total billed charges,24% of total billed charges ,33.07,31.2,,,percent of total billed charges,31.2% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,25.44,24,,,percent of total billed charges,24% of total billed charges ,25.44,24,,,percent of total billed charges,24% of total billed charges ,25.44,84.8,
NF-SECTRAL CAP 200MG,7000180,CDM,250,RC,,,Outpatient,,,10.5,5.25,,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,8.4,80,,,percent of total billed charges,80% of total billed charges ,2.55,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,3.28,31.2,,,percent of total billed charges,31.2% of total billed charges,8.4,80,,,percent of total billed charges,80% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,8.4,
NF-TYSABRI INTRAVENOUS SOLUTION 20MG/1ML,7000181,CDM,250,RC,,,Outpatient,,,1123.5,561.75,,301.77,26.86,,,percent of total billed charges,26.86% of total billed charges,842.63,75,,,percent of total billed charges,75% of total billed charges ,842.63,75,,,percent of total billed charges,75% of total billed charges ,269.64,24,,,percent of total billed charges,24% of total billed charges ,842.63,75,,,percent of total billed charges,75% of total billed charges ,842.63,75,,,percent of total billed charges,75% of total billed charges ,898.8,80,,,percent of total billed charges,80% of total billed charges ,272.34,24.24,,,percent of total billed charges,24.24% of total billed charges ,566.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,842.63,75,,,percent of total billed charges,75% of total billed charges ,275.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,301.77,26.86,,,percent of total billed charges,26.86% of total billed charges,269.64,24,,,percent of total billed charges,24% of total billed charges ,350.53,31.2,,,percent of total billed charges,31.2% of total billed charges,898.8,80,,,percent of total billed charges,80% of total billed charges,269.64,24,,,percent of total billed charges,24% of total billed charges ,269.64,24,,,percent of total billed charges,24% of total billed charges ,269.64,898.8,
NF-DEMEROL HYDROCHLORIDE TABLET 50MG,7000182,CDM,250,RC,,,Outpatient,,,6,3,,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.8,80,,,percent of total billed charges,80% of total billed charges ,1.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.87,31.2,,,percent of total billed charges,31.2% of total billed charges,4.8,80,,,percent of total billed charges,80% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,4.8,
NF-VESICARE ORAL TABLET 5MG,7000184,CDM,250,RC,,,Outpatient,,,26,13,,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,20.8,
NF-TIAZAC 24 HR CAP 120MG,7000185,CDM,250,RC,,,Outpatient,,,3,1.5,,0.81,26.86,,,percent of total billed charges,26.86% of total billed charges,2.25,75,,,percent of total billed charges,75% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,0.72,24,,,percent of total billed charges,24% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,2.4,80,,,percent of total billed charges,80% of total billed charges ,0.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,1.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,2.25,75,,,percent of total billed charges,75% of total billed charges ,0.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.81,26.86,,,percent of total billed charges,26.86% of total billed charges,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.94,31.2,,,percent of total billed charges,31.2% of total billed charges,2.4,80,,,percent of total billed charges,80% of total billed charges,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.72,24,,,percent of total billed charges,24% of total billed charges ,0.72,2.4,
NF-RANITIDINE HCL CAP 150MG,7000186,CDM,250,RC,,,Outpatient,,,5,2.5,,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,4,80,,,percent of total billed charges,80% of total billed charges ,1.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,2.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,3.75,75,,,percent of total billed charges,75% of total billed charges ,1.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.34,26.86,,,percent of total billed charges,26.86% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.56,31.2,,,percent of total billed charges,31.2% of total billed charges,4,80,,,percent of total billed charges,80% of total billed charges,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,24,,,percent of total billed charges,24% of total billed charges ,1.2,4,
NF-NABUMETONE ORAL TABLET 500MG,7000188,CDM,250,RC,,,Outpatient,,,6,3,,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,4.8,80,,,percent of total billed charges,80% of total billed charges ,1.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,4.5,75,,,percent of total billed charges,75% of total billed charges ,1.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.61,26.86,,,percent of total billed charges,26.86% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.87,31.2,,,percent of total billed charges,31.2% of total billed charges,4.8,80,,,percent of total billed charges,80% of total billed charges,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,24,,,percent of total billed charges,24% of total billed charges ,1.44,4.8,
TAMBOCOR (FLECAINIDE) 100MG TAB,7000189,CDM,259,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
NF-PROCARDIA XL TABLET 90MG,7000190,CDM,250,RC,,,Outpatient,,,13.5,6.75,,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.8,80,,,percent of total billed charges,80% of total billed charges ,3.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,4.21,31.2,,,percent of total billed charges,31.2% of total billed charges,10.8,80,,,percent of total billed charges,80% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,10.8,
NF-KETOTIFEN FUMARATE OPHTH SOLN 0.025%,7000191,CDM,250,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
NF-TOPROL XL EXTENDED RELEASE TABLET 100,7000192,CDM,250,RC,,,Outpatient,,,7,3.5,,1.88,26.86,,,percent of total billed charges,26.86% of total billed charges,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,5.6,80,,,percent of total billed charges,80% of total billed charges ,1.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,3.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,5.25,75,,,percent of total billed charges,75% of total billed charges ,1.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.88,26.86,,,percent of total billed charges,26.86% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,2.18,31.2,,,percent of total billed charges,31.2% of total billed charges,5.6,80,,,percent of total billed charges,80% of total billed charges,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,24,,,percent of total billed charges,24% of total billed charges ,1.68,5.6,
WELLBUTRIN XR (BUPROPION SR) 150MG (BID),7000194,CDM,259,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ZZZFAMOTIDINE INJ(PEPCID)10MG/ML(40MG/4M,7000195,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ZZZNF-ACTONEL ORAL TABLET 150MG,7000197,CDM,250,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
NF-SORIATANE CAP 10MG,7000198,CDM,250,RC,,,Outpatient,,,110,55,,29.55,26.86,,,percent of total billed charges,26.86% of total billed charges,82.5,75,,,percent of total billed charges,75% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.55,26.86,,,percent of total billed charges,26.86% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,88,
NF-VICTOZA SUBCUTANEOUS SOLUTION 6MG/1ML,7000200,CDM,250,RC,,,Outpatient,,,208,104,,55.87,26.86,,,percent of total billed charges,26.86% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges ,156,75,,,percent of total billed charges,75% of total billed charges ,49.92,24,,,percent of total billed charges,24% of total billed charges ,156,75,,,percent of total billed charges,75% of total billed charges ,156,75,,,percent of total billed charges,75% of total billed charges ,166.4,80,,,percent of total billed charges,80% of total billed charges ,50.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,104.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,156,75,,,percent of total billed charges,75% of total billed charges ,50.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,55.87,26.86,,,percent of total billed charges,26.86% of total billed charges,49.92,24,,,percent of total billed charges,24% of total billed charges ,64.9,31.2,,,percent of total billed charges,31.2% of total billed charges,166.4,80,,,percent of total billed charges,80% of total billed charges,49.92,24,,,percent of total billed charges,24% of total billed charges ,49.92,24,,,percent of total billed charges,24% of total billed charges ,49.92,166.4,
ZZZLACTATED RINGERS IV 500ML,7000201,CDM,636,RC,J7120,HCPCS,Outpatient,,,48.5,24.25,,2.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.8,80,,,percent of total billed charges,80% of total billed charges ,11.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.64,24,,,percent of total billed charges,24% of total billed charges ,15.13,31.2,,,percent of total billed charges,31.2% of total billed charges,38.8,80,,,percent of total billed charges,80% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,2.59,38.8,
NF-MESTINON TABLET 60MG,7000202,CDM,250,RC,,,Outpatient,,,2,1,,0.54,26.86,,,percent of total billed charges,26.86% of total billed charges,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,0.48,24,,,percent of total billed charges,24% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,1.6,80,,,percent of total billed charges,80% of total billed charges ,0.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,1.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,1.5,75,,,percent of total billed charges,75% of total billed charges ,0.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.54,26.86,,,percent of total billed charges,26.86% of total billed charges,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.62,31.2,,,percent of total billed charges,31.2% of total billed charges,1.6,80,,,percent of total billed charges,80% of total billed charges,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.48,24,,,percent of total billed charges,24% of total billed charges ,0.48,1.6,
LIDOCAINE HCL TOP SOL 4% 50ML BOTTLE,7000207,CDM,259,RC,,,Outpatient,,,300,150,,80.58,26.86,,,percent of total billed charges,26.86% of total billed charges,225,75,,,percent of total billed charges,75% of total billed charges ,225,75,,,percent of total billed charges,75% of total billed charges ,72,24,,,percent of total billed charges,24% of total billed charges ,225,75,,,percent of total billed charges,75% of total billed charges ,225,75,,,percent of total billed charges,75% of total billed charges ,240,80,,,percent of total billed charges,80% of total billed charges ,72.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,151.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,225,75,,,percent of total billed charges,75% of total billed charges ,73.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,80.58,26.86,,,percent of total billed charges,26.86% of total billed charges,72,24,,,percent of total billed charges,24% of total billed charges ,93.6,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,72,24,,,percent of total billed charges,24% of total billed charges ,72,24,,,percent of total billed charges,24% of total billed charges ,72,240,
ZZZCEFAZOLIN 1GM IN D5W 50ML PREMIX,7000208,CDM,258,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
NF-DANTRIUM CAP 25MG,7000215,CDM,250,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
VANCOMYCIN HCL 125MG CAPSULE,7000224,CDM,259,RC,,,Outpatient,,,93.5,46.75,,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,74.8,80,,,percent of total billed charges,80% of total billed charges ,22.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,29.17,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,74.8,
ZZZOMEPRAZOLE DR 20MG CAPSULE,7000225,CDM,259,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
HYDROCORTISONE 1% CREAM,7000226,CDM,259,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
NF-MONUROL POWDER FOR SOLUTION 3GM,7000227,CDM,250,RC,,,Outpatient,,,189.5,94.75,,50.9,26.86,,,percent of total billed charges,26.86% of total billed charges,142.13,75,,,percent of total billed charges,75% of total billed charges ,142.13,75,,,percent of total billed charges,75% of total billed charges ,45.48,24,,,percent of total billed charges,24% of total billed charges ,142.13,75,,,percent of total billed charges,75% of total billed charges ,142.13,75,,,percent of total billed charges,75% of total billed charges ,151.6,80,,,percent of total billed charges,80% of total billed charges ,45.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,95.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,142.13,75,,,percent of total billed charges,75% of total billed charges ,46.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,50.9,26.86,,,percent of total billed charges,26.86% of total billed charges,45.48,24,,,percent of total billed charges,24% of total billed charges ,59.12,31.2,,,percent of total billed charges,31.2% of total billed charges,151.6,80,,,percent of total billed charges,80% of total billed charges,45.48,24,,,percent of total billed charges,24% of total billed charges ,45.48,24,,,percent of total billed charges,24% of total billed charges ,45.48,151.6,
BANATROL PLUS 10.75 GM PACKET,7000239,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZRANITIDINE INJECTION 150MG/6ML,7000247,CDM,259,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
DILTIAZEM HCL INJ 125MG/25ML,7000248,CDM,250,RC,,,Outpatient,,,77.5,38.75,,20.82,26.86,,,percent of total billed charges,26.86% of total billed charges,58.13,75,,,percent of total billed charges,75% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,18.6,24,,,percent of total billed charges,24% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,62,80,,,percent of total billed charges,80% of total billed charges ,18.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,18.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.82,26.86,,,percent of total billed charges,26.86% of total billed charges,18.6,24,,,percent of total billed charges,24% of total billed charges ,24.18,31.2,,,percent of total billed charges,31.2% of total billed charges,62,80,,,percent of total billed charges,80% of total billed charges,18.6,24,,,percent of total billed charges,24% of total billed charges ,18.6,24,,,percent of total billed charges,24% of total billed charges ,18.6,62,
VITAMIN D3 400 UNIT (10MCG) TAB,7000250,CDM,259,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZPEPCID INJ(FAMOT)200MG/20ML(10MG/ML),7000252,CDM,259,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
LAMISIL (TERBINAFINE) TAB,7000254,CDM,250,RC,,,Outpatient,,,49.5,24.75,,13.3,26.86,,,percent of total billed charges,26.86% of total billed charges,37.13,75,,,percent of total billed charges,75% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,11.88,24,,,percent of total billed charges,24% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,39.6,80,,,percent of total billed charges,80% of total billed charges ,12,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,12.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.3,26.86,,,percent of total billed charges,26.86% of total billed charges,11.88,24,,,percent of total billed charges,24% of total billed charges ,15.44,31.2,,,percent of total billed charges,31.2% of total billed charges,39.6,80,,,percent of total billed charges,80% of total billed charges,11.88,24,,,percent of total billed charges,24% of total billed charges ,11.88,24,,,percent of total billed charges,24% of total billed charges ,11.88,39.6,
LIDOCAINE 1% INJ 20ML MDV,7000267,CDM,636,RC,J2001,HCPCS,Outpatient,,,15.5,7.75,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,0.03,12.4,
MAGNESIUM SULFATE 5GM/10ML INJECTION,7000294,CDM,636,RC,J3475,HCPCS,Outpatient,,,21.5,10.75,,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,0.69,17.2,
ZZZMICONAZOLE 3 VAGINAL SUPP,7000296,CDM,259,RC,,,Outpatient,,,39,19.5,,10.48,26.86,,,percent of total billed charges,26.86% of total billed charges,29.25,75,,,percent of total billed charges,75% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,9.36,24,,,percent of total billed charges,24% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,31.2,80,,,percent of total billed charges,80% of total billed charges ,9.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,9.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.48,26.86,,,percent of total billed charges,26.86% of total billed charges,9.36,24,,,percent of total billed charges,24% of total billed charges ,12.17,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,9.36,24,,,percent of total billed charges,24% of total billed charges ,9.36,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,
ZZZTHORAZINE (CHLORPROMAZINE) 50MG TAB,7000320,CDM,259,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
PERPHENAZINE 4MG,7000322,CDM,250,RC,,,Outpatient,,,10.5,5.25,,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,8.4,80,,,percent of total billed charges,80% of total billed charges ,2.55,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,3.28,31.2,,,percent of total billed charges,31.2% of total billed charges,8.4,80,,,percent of total billed charges,80% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,8.4,
PERPHENAZINE 4MG,7000323,CDM,250,RC,,,Outpatient,,,9.25,4.63,,2.48,26.86,,,percent of total billed charges,26.86% of total billed charges,6.94,75,,,percent of total billed charges,75% of total billed charges ,6.94,75,,,percent of total billed charges,75% of total billed charges ,2.22,24,,,percent of total billed charges,24% of total billed charges ,6.94,75,,,percent of total billed charges,75% of total billed charges ,6.94,75,,,percent of total billed charges,75% of total billed charges ,7.4,80,,,percent of total billed charges,80% of total billed charges ,2.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,6.94,75,,,percent of total billed charges,75% of total billed charges ,2.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.48,26.86,,,percent of total billed charges,26.86% of total billed charges,2.22,24,,,percent of total billed charges,24% of total billed charges ,2.89,31.2,,,percent of total billed charges,31.2% of total billed charges,7.4,80,,,percent of total billed charges,80% of total billed charges,2.22,24,,,percent of total billed charges,24% of total billed charges ,2.22,24,,,percent of total billed charges,24% of total billed charges ,2.22,7.4,
NF-Sodium Bicarbonate Oral Tablet 325MG,7000334,CDM,250,RC,,,Outpatient,,,8851,4425.5,,2377.38,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,2124.24,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,7080.8,80,,,percent of total billed charges,80% of total billed charges ,2145.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,4460.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,6638.25,75,,,percent of total billed charges,75% of total billed charges ,2166.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,2377.38,26.86,,,percent of total billed charges,26.86% of total billed charges,2124.24,24,,,percent of total billed charges,24% of total billed charges ,2761.51,31.2,,,percent of total billed charges,31.2% of total billed charges,7080.8,80,,,percent of total billed charges,80% of total billed charges,2124.24,24,,,percent of total billed charges,24% of total billed charges ,2124.24,24,,,percent of total billed charges,24% of total billed charges ,2124.24,7080.8,
NF-Cardizem LA Oral Tab ER 300MG,7000335,CDM,250,RC,,,Outpatient,,,2292798,1146399,,615845.54,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,550271.52,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,1834238.4,80,,,percent of total billed charges,80% of total billed charges ,555774.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,1155570.19,50.4,,,percent of total billed charges,50.4% of total billed charges ,1719598.5,75,,,percent of total billed charges,75% of total billed charges ,561276.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,615845.54,26.86,,,percent of total billed charges,26.86% of total billed charges,550271.52,24,,,percent of total billed charges,24% of total billed charges ,715352.98,31.2,,,percent of total billed charges,31.2% of total billed charges,1834238.4,80,,,percent of total billed charges,80% of total billed charges,550271.52,24,,,percent of total billed charges,24% of total billed charges ,550271.52,24,,,percent of total billed charges,24% of total billed charges ,4394,1834238.4,
NF-Dulera Inh Aer Pwd 5MCG-200MCG/Act,7000336,CDM,250,RC,,,Outpatient,,,6925503,3462751.5,,1860190.11,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,1662120.72,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,5540402.4,80,,,percent of total billed charges,80% of total billed charges ,1678741.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,3490453.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,5194127.25,75,,,percent of total billed charges,75% of total billed charges ,1695363.13,24.48,,,percent of total billed charges,24.48% of total billed charges ,1860190.11,26.86,,,percent of total billed charges,26.86% of total billed charges,1662120.72,24,,,percent of total billed charges,24% of total billed charges ,2160756.94,31.2,,,percent of total billed charges,31.2% of total billed charges,5540402.4,80,,,percent of total billed charges,80% of total billed charges,1662120.72,24,,,percent of total billed charges,24% of total billed charges ,1662120.72,24,,,percent of total billed charges,24% of total billed charges ,4394,5540402.4,
NF-Xarelto Oral Tablet 20MG,7000337,CDM,250,RC,,,Outpatient,,,3585110,1792555,,962960.55,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,860426.4,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,2868088,80,,,percent of total billed charges,80% of total billed charges ,869030.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,1806895.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,2688832.5,75,,,percent of total billed charges,75% of total billed charges ,877634.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,962960.55,26.86,,,percent of total billed charges,26.86% of total billed charges,860426.4,24,,,percent of total billed charges,24% of total billed charges ,1118554.32,31.2,,,percent of total billed charges,31.2% of total billed charges,2868088,80,,,percent of total billed charges,80% of total billed charges,860426.4,24,,,percent of total billed charges,24% of total billed charges ,860426.4,24,,,percent of total billed charges,24% of total billed charges ,4394,2868088,
NF-Ranexa Extended-Release Tablet 1000MG,7000340,CDM,250,RC,,,Outpatient,,,2657322,1328661,,713756.69,26.86,,,percent of total billed charges,26.86% of total billed charges,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,637757.28,24,,,percent of total billed charges,24% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,4394,75,,,percent of total billed charges,75% of total billed charges ,2125857.6,80,,,percent of total billed charges,80% of total billed charges ,644134.85,24.24,,,percent of total billed charges,24.24% of total billed charges ,1339290.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,1992991.5,75,,,percent of total billed charges,75% of total billed charges ,650512.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,713756.69,26.86,,,percent of total billed charges,26.86% of total billed charges,637757.28,24,,,percent of total billed charges,24% of total billed charges ,829084.46,31.2,,,percent of total billed charges,31.2% of total billed charges,2125857.6,80,,,percent of total billed charges,80% of total billed charges,637757.28,24,,,percent of total billed charges,24% of total billed charges ,637757.28,24,,,percent of total billed charges,24% of total billed charges ,4394,2125857.6,
ZZZENSURE COMPLETE 237ML BOTTLE,7000360,CDM,270,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ZZZENSURE COMPLETE 237ML BOTTLE,7000363,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ZZZENSURE COMPLETE CHOC 237ML BOTTLE,7000364,CDM,270,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
MAXIPIME (CEFEPIME) 2GM INJ,7000373,CDM,636,RC,J0692,HCPCS,Outpatient,,,69,34.5,,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.2,80,,,percent of total billed charges,80% of total billed charges ,16.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,21.53,31.2,,,percent of total billed charges,31.2% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,55.2,
ACETYLCYSTEINE 6GM/30ML INJECTION,7000391,CDM,636,RC,J0132,HCPCS,Outpatient,,,933,466.5,,250.6,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,223.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,746.4,80,,,percent of total billed charges,80% of total billed charges ,226.16,24.24,,,percent of total billed charges,24.24% of total billed charges ,470.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,699.75,75,,,percent of total billed charges,75% of total billed charges ,228.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,250.6,26.86,,,percent of total billed charges,26.86% of total billed charges,223.92,24,,,percent of total billed charges,24% of total billed charges ,291.1,31.2,,,percent of total billed charges,31.2% of total billed charges,746.4,80,,,percent of total billed charges,80% of total billed charges,223.92,24,,,percent of total billed charges,24% of total billed charges ,223.92,24,,,percent of total billed charges,24% of total billed charges ,223.92,746.4,
ZZZLACTULOSE 10GM/15ML SOL 15ML UD,7000447,CDM,250,RC,,,Outpatient,,,13.5,6.75,,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.8,80,,,percent of total billed charges,80% of total billed charges ,3.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,4.21,31.2,,,percent of total billed charges,31.2% of total billed charges,10.8,80,,,percent of total billed charges,80% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,10.8,
D5+1/2NS 500ML IV BAG,7000489,CDM,636,RC,J7042,HCPCS,Outpatient,,,48.5,24.25,,1.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.8,80,,,percent of total billed charges,80% of total billed charges ,11.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.64,24,,,percent of total billed charges,24% of total billed charges ,15.13,31.2,,,percent of total billed charges,31.2% of total billed charges,38.8,80,,,percent of total billed charges,80% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,1.59,38.8,
ZAROXOLYN (METOLAZONE) 5MG TAB,7000491,CDM,250,RC,,,Outpatient,,,29,14.5,,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,23.2,80,,,percent of total billed charges,80% of total billed charges ,7.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,7.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,9.05,31.2,,,percent of total billed charges,31.2% of total billed charges,23.2,80,,,percent of total billed charges,80% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,23.2,
TORADOL (KETOROLAC) 15MG/ML INJ,7000537,CDM,636,RC,J1885,HCPCS,Outpatient,,,24.5,12.25,,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,0.49,19.6,
TESSALON (BENZONATATE) 200MG CAP,7000538,CDM,250,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
ROXANOL (MORPHINE) 20MG/ML ORAL SOLN,7000553,CDM,250,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
"PENICILLIN G  5,000,000 UNIT",7000584,CDM,636,RC,J2540,HCPCS,Outpatient,,,84.5,42.25,,0.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,67.6,80,,,percent of total billed charges,80% of total billed charges ,20.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,20.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.28,24,,,percent of total billed charges,24% of total billed charges ,26.36,31.2,,,percent of total billed charges,31.2% of total billed charges,67.6,80,,,percent of total billed charges,80% of total billed charges,20.28,24,,,percent of total billed charges,24% of total billed charges ,20.28,24,,,percent of total billed charges,24% of total billed charges ,0.77,67.6,
TOBRAMYCIN 80MG/2ML,7000610,CDM,636,RC,J3260,HCPCS,Outpatient,,,22.5,11.25,,2.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,2.66,18,
ZZZLIDOCAINE 0.4% IN D5W SOLN 500ML IV,7000623,CDM,636,RC,J2001,HCPCS,Outpatient,,,48.5,24.25,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.8,80,,,percent of total billed charges,80% of total billed charges ,11.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.64,24,,,percent of total billed charges,24% of total billed charges ,15.13,31.2,,,percent of total billed charges,31.2% of total billed charges,38.8,80,,,percent of total billed charges,80% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,0.03,38.8,
ZZZLIDOCAINE 0.4% IN D5W SOLN 250ML IV,7000624,CDM,636,RC,J2001,HCPCS,Outpatient,,,48.5,24.25,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.8,80,,,percent of total billed charges,80% of total billed charges ,11.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.64,24,,,percent of total billed charges,24% of total billed charges ,15.13,31.2,,,percent of total billed charges,31.2% of total billed charges,38.8,80,,,percent of total billed charges,80% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,0.03,38.8,
1/2NS (0.45% SOD CHLORIDE) 250ML,7000625,CDM,636,RC,J7050,HCPCS,Outpatient,,,44.5,22.25,,0.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.6,80,,,percent of total billed charges,80% of total billed charges ,10.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,10.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.68,24,,,percent of total billed charges,24% of total billed charges ,13.88,31.2,,,percent of total billed charges,31.2% of total billed charges,35.6,80,,,percent of total billed charges,80% of total billed charges,10.68,24,,,percent of total billed charges,24% of total billed charges ,10.68,24,,,percent of total billed charges,24% of total billed charges ,0.67,35.6,
DILAUDID (HYDROMORPHONE) 1MG/ML INJ,7000628,CDM,636,RC,J1170,HCPCS,Outpatient,,,34,17,,4.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,4.59,27.2,
ZZZARICEPT (DONEPEZIL) 10MG TAB,7000645,CDM,250,RC,,,Outpatient,,,42,21,,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,33.6,80,,,percent of total billed charges,80% of total billed charges ,10.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,13.1,31.2,,,percent of total billed charges,31.2% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,33.6,
DAKINS (SOD HYPOCHLORITE) 0.125% SOL,7000676,CDM,250,RC,,,Outpatient,,,73,36.5,,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,58.4,
ZZZPRADAXA (DABIGATRAN ETEX)75MG CAP,7000689,CDM,250,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
"VITAMIN D3 50,000 UNIT CAPSULE",7000690,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZCHLORHEXIDINE GLUCO ORAL RINSE 0.12%,7000697,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
XYLOCAINE-MPF 0.5% 250MG/50ML,7000718,CDM,636,RC,J2001,HCPCS,Outpatient,,,84.5,42.25,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,67.6,80,,,percent of total billed charges,80% of total billed charges ,20.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,20.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.28,24,,,percent of total billed charges,24% of total billed charges ,26.36,31.2,,,percent of total billed charges,31.2% of total billed charges,67.6,80,,,percent of total billed charges,80% of total billed charges,20.28,24,,,percent of total billed charges,24% of total billed charges ,20.28,24,,,percent of total billed charges,24% of total billed charges ,0.03,67.6,
MUCOMYST (ACETYLCYSTEINE) 4ML 20% SOLU,7000729,CDM,250,RC,,,Outpatient,,,83.25,41.63,,22.36,26.86,,,percent of total billed charges,26.86% of total billed charges,62.44,75,,,percent of total billed charges,75% of total billed charges ,62.44,75,,,percent of total billed charges,75% of total billed charges ,19.98,24,,,percent of total billed charges,24% of total billed charges ,62.44,75,,,percent of total billed charges,75% of total billed charges ,62.44,75,,,percent of total billed charges,75% of total billed charges ,66.6,80,,,percent of total billed charges,80% of total billed charges ,20.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.44,75,,,percent of total billed charges,75% of total billed charges ,20.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.36,26.86,,,percent of total billed charges,26.86% of total billed charges,19.98,24,,,percent of total billed charges,24% of total billed charges ,25.97,31.2,,,percent of total billed charges,31.2% of total billed charges,66.6,80,,,percent of total billed charges,80% of total billed charges,19.98,24,,,percent of total billed charges,24% of total billed charges ,19.98,24,,,percent of total billed charges,24% of total billed charges ,19.98,66.6,
URO-JET (LIDOCAINE 2%) JELLY - TOPICAL,7000746,CDM,250,RC,,,Outpatient,,,86.5,43.25,,23.23,26.86,,,percent of total billed charges,26.86% of total billed charges,64.88,75,,,percent of total billed charges,75% of total billed charges ,64.88,75,,,percent of total billed charges,75% of total billed charges ,20.76,24,,,percent of total billed charges,24% of total billed charges ,64.88,75,,,percent of total billed charges,75% of total billed charges ,64.88,75,,,percent of total billed charges,75% of total billed charges ,69.2,80,,,percent of total billed charges,80% of total billed charges ,20.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,43.6,50.4,,,percent of total billed charges,50.4% of total billed charges ,64.88,75,,,percent of total billed charges,75% of total billed charges ,21.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.23,26.86,,,percent of total billed charges,26.86% of total billed charges,20.76,24,,,percent of total billed charges,24% of total billed charges ,26.99,31.2,,,percent of total billed charges,31.2% of total billed charges,69.2,80,,,percent of total billed charges,80% of total billed charges,20.76,24,,,percent of total billed charges,24% of total billed charges ,20.76,24,,,percent of total billed charges,24% of total billed charges ,20.76,69.2,
ZZZFLUZONE QUAD  0.5ML 2016-2017,7000766,CDM,259,RC,90686,HCPCS,Outpatient,,,73,36.5,,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,58.4,
ZZZFLUZONE HI-DOSE)0.5ML 2016-20,7000767,CDM,636,RC,90662,HCPCS,Outpatient,,,131,65.5,,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,104.8,80,,,percent of total billed charges,80% of total billed charges ,31.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,66.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,98.25,75,,,percent of total billed charges,75% of total billed charges ,32.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.44,24,,,percent of total billed charges,24% of total billed charges ,40.87,31.2,,,percent of total billed charges,31.2% of total billed charges,104.8,80,,,percent of total billed charges,80% of total billed charges,31.44,24,,,percent of total billed charges,24% of total billed charges ,31.44,24,,,percent of total billed charges,24% of total billed charges ,31.44,104.8,
WELLBUTRIN (BUPROPION HCL)  75MG,7000770,CDM,259,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
DAKINS (SOD HYPOCHLORITE) 0.50% SOL,7000776,CDM,250,RC,,,Outpatient,,,93,46.5,,24.98,26.86,,,percent of total billed charges,26.86% of total billed charges,69.75,75,,,percent of total billed charges,75% of total billed charges ,69.75,75,,,percent of total billed charges,75% of total billed charges ,22.32,24,,,percent of total billed charges,24% of total billed charges ,69.75,75,,,percent of total billed charges,75% of total billed charges ,69.75,75,,,percent of total billed charges,75% of total billed charges ,74.4,80,,,percent of total billed charges,80% of total billed charges ,22.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,46.87,50.4,,,percent of total billed charges,50.4% of total billed charges ,69.75,75,,,percent of total billed charges,75% of total billed charges ,22.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.98,26.86,,,percent of total billed charges,26.86% of total billed charges,22.32,24,,,percent of total billed charges,24% of total billed charges ,29.02,31.2,,,percent of total billed charges,31.2% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,22.32,24,,,percent of total billed charges,24% of total billed charges ,22.32,24,,,percent of total billed charges,24% of total billed charges ,22.32,74.4,
ZZZMEROPENEM 1GM / NS 50ML PREMIX,7000778,CDM,636,RC,J2185,HCPCS,Outpatient,,,138,69,,0.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,110.4,80,,,percent of total billed charges,80% of total billed charges ,33.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,69.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,33.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.12,24,,,percent of total billed charges,24% of total billed charges ,43.06,31.2,,,percent of total billed charges,31.2% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,33.12,24,,,percent of total billed charges,24% of total billed charges ,33.12,24,,,percent of total billed charges,24% of total billed charges ,0.45,110.4,
MORPHINE SULFATE 4MG/ML INJ,7000782,CDM,636,RC,J2270,HCPCS,Outpatient,,,25.5,12.75,,4.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.4,80,,,percent of total billed charges,80% of total billed charges ,6.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.13,75,,,percent of total billed charges,75% of total billed charges ,6.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.12,24,,,percent of total billed charges,24% of total billed charges ,7.96,31.2,,,percent of total billed charges,31.2% of total billed charges,20.4,80,,,percent of total billed charges,80% of total billed charges,6.12,24,,,percent of total billed charges,24% of total billed charges ,6.12,24,,,percent of total billed charges,24% of total billed charges ,4.67,20.4,
ZZZHYOSCYAMINE .125MG/5ML ELIX,7000787,CDM,250,RC,,,Outpatient,,,66,33,,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,52.8,80,,,percent of total billed charges,80% of total billed charges ,16,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,16.16,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,20.59,31.2,,,percent of total billed charges,31.2% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,52.8,
VANCOMYCIN 50MG/ML ORAL SOLU 300ML,7000790,CDM,250,RC,,,Outpatient,,,563.5,281.75,,151.36,26.86,,,percent of total billed charges,26.86% of total billed charges,422.63,75,,,percent of total billed charges,75% of total billed charges ,422.63,75,,,percent of total billed charges,75% of total billed charges ,135.24,24,,,percent of total billed charges,24% of total billed charges ,422.63,75,,,percent of total billed charges,75% of total billed charges ,422.63,75,,,percent of total billed charges,75% of total billed charges ,450.8,80,,,percent of total billed charges,80% of total billed charges ,136.59,24.24,,,percent of total billed charges,24.24% of total billed charges ,284,50.4,,,percent of total billed charges,50.4% of total billed charges ,422.63,75,,,percent of total billed charges,75% of total billed charges ,137.94,24.48,,,percent of total billed charges,24.48% of total billed charges ,151.36,26.86,,,percent of total billed charges,26.86% of total billed charges,135.24,24,,,percent of total billed charges,24% of total billed charges ,175.81,31.2,,,percent of total billed charges,31.2% of total billed charges,450.8,80,,,percent of total billed charges,80% of total billed charges,135.24,24,,,percent of total billed charges,24% of total billed charges ,135.24,24,,,percent of total billed charges,24% of total billed charges ,135.24,450.8,
DALVANCE (DALBAVANCIN) 500MG IV,7000793,CDM,636,RC,J0875,HCPCS,Outpatient,,,8042,4021,,15.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1930.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6433.6,80,,,percent of total billed charges,80% of total billed charges ,1949.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,4053.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,6031.5,75,,,percent of total billed charges,75% of total billed charges ,1968.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,1930.08,24,,,percent of total billed charges,24% of total billed charges ,2509.1,31.2,,,percent of total billed charges,31.2% of total billed charges,6433.6,80,,,percent of total billed charges,80% of total billed charges,1930.08,24,,,percent of total billed charges,24% of total billed charges ,1930.08,24,,,percent of total billed charges,24% of total billed charges ,15.29,6433.6,
CETACAINE SPRAY,7000803,CDM,259,RC,,,Outpatient,,,361.5,180.75,,97.1,26.86,,,percent of total billed charges,26.86% of total billed charges,271.13,75,,,percent of total billed charges,75% of total billed charges ,271.13,75,,,percent of total billed charges,75% of total billed charges ,86.76,24,,,percent of total billed charges,24% of total billed charges ,271.13,75,,,percent of total billed charges,75% of total billed charges ,271.13,75,,,percent of total billed charges,75% of total billed charges ,289.2,80,,,percent of total billed charges,80% of total billed charges ,87.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,182.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,271.13,75,,,percent of total billed charges,75% of total billed charges ,88.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,97.1,26.86,,,percent of total billed charges,26.86% of total billed charges,86.76,24,,,percent of total billed charges,24% of total billed charges ,112.79,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,86.76,24,,,percent of total billed charges,24% of total billed charges ,86.76,24,,,percent of total billed charges,24% of total billed charges ,86.76,289.2,
ZZZPREVNAR 13,7000804,CDM,636,RC,90670,HCPCS,Outpatient,,,937.5,468.75,,257.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,225,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,750,80,,,percent of total billed charges,80% of total billed charges ,227.25,24.24,,,percent of total billed charges,24.24% of total billed charges ,472.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,703.13,75,,,percent of total billed charges,75% of total billed charges ,229.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,257.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,225,24,,,percent of total billed charges,24% of total billed charges ,292.5,31.2,,,percent of total billed charges,31.2% of total billed charges,750,80,,,percent of total billed charges,80% of total billed charges,225,24,,,percent of total billed charges,24% of total billed charges ,225,24,,,percent of total billed charges,24% of total billed charges ,225,750,
MAG SULFATE/ D5W IVPB  1GM/100ML PREMI,7000806,CDM,636,RC,J3475,HCPCS,Outpatient,,,64,32,,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,0.69,51.2,
MARCAINE W/EPI (BUP/EPI) 0.5% 30ML,7000828,CDM,250,RC,,,Outpatient,,,64,32,,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,51.2,
BENEPROTEIN PROTEIN POWDER 7GM PKT,7000837,CDM,259,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZZOVIRAX (ACYCLOVIR) 5% OINTMENT 5GM,7000839,CDM,250,RC,,,Outpatient,,,991,495.5,,266.18,26.86,,,percent of total billed charges,26.86% of total billed charges,743.25,75,,,percent of total billed charges,75% of total billed charges ,743.25,75,,,percent of total billed charges,75% of total billed charges ,237.84,24,,,percent of total billed charges,24% of total billed charges ,743.25,75,,,percent of total billed charges,75% of total billed charges ,743.25,75,,,percent of total billed charges,75% of total billed charges ,792.8,80,,,percent of total billed charges,80% of total billed charges ,240.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,499.46,50.4,,,percent of total billed charges,50.4% of total billed charges ,743.25,75,,,percent of total billed charges,75% of total billed charges ,242.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,266.18,26.86,,,percent of total billed charges,26.86% of total billed charges,237.84,24,,,percent of total billed charges,24% of total billed charges ,309.19,31.2,,,percent of total billed charges,31.2% of total billed charges,792.8,80,,,percent of total billed charges,80% of total billed charges,237.84,24,,,percent of total billed charges,24% of total billed charges ,237.84,24,,,percent of total billed charges,24% of total billed charges ,237.84,792.8,
KETALAR (KETAMINE) 100MG/ML 5ML,7000842,CDM,250,RC,,,Outpatient,,,85.5,42.75,,22.97,26.86,,,percent of total billed charges,26.86% of total billed charges,64.13,75,,,percent of total billed charges,75% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,20.52,24,,,percent of total billed charges,24% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,68.4,80,,,percent of total billed charges,80% of total billed charges ,20.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,43.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,20.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.97,26.86,,,percent of total billed charges,26.86% of total billed charges,20.52,24,,,percent of total billed charges,24% of total billed charges ,26.68,31.2,,,percent of total billed charges,31.2% of total billed charges,68.4,80,,,percent of total billed charges,80% of total billed charges,20.52,24,,,percent of total billed charges,24% of total billed charges ,20.52,24,,,percent of total billed charges,24% of total billed charges ,20.52,68.4,
ZZZNUPERCAINAL OINTMENT 1% 28GM,7000867,CDM,259,RC,,,Outpatient,,,45.5,22.75,,12.22,26.86,,,percent of total billed charges,26.86% of total billed charges,34.13,75,,,percent of total billed charges,75% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.22,26.86,,,percent of total billed charges,26.86% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,36.4,
DIAMOX ER (ACETAZOLAMIDE) 500MG,7000893,CDM,250,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
ZZZLEVSIN 0.125MG/5ML ELIXIR,7000901,CDM,250,RC,,,Outpatient,,,66,33,,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,52.8,80,,,percent of total billed charges,80% of total billed charges ,16,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,16.16,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,20.59,31.2,,,percent of total billed charges,31.2% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,52.8,
LIDOCAINE 2% ORAL TOP SOLN 100ML,7000907,CDM,259,RC,,,Outpatient,,,75,37.5,,20.15,26.86,,,percent of total billed charges,26.86% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,18,24,,,percent of total billed charges,24% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,60,80,,,percent of total billed charges,80% of total billed charges ,18.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,18.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.15,26.86,,,percent of total billed charges,26.86% of total billed charges,18,24,,,percent of total billed charges,24% of total billed charges ,23.4,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,18,24,,,percent of total billed charges,24% of total billed charges ,18,24,,,percent of total billed charges,24% of total billed charges ,18,60,
ZZZTETRACAINE 0.5% OPTH SOLN 2ML,7000920,CDM,250,RC,,,Outpatient,,,64,32,,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,51.2,
LIDOCAINE & PRILOCAINE CM 2.5%/2.5% 5GM,7000921,CDM,259,RC,,,Outpatient,,,62,31,,16.65,26.86,,,percent of total billed charges,26.86% of total billed charges,46.5,75,,,percent of total billed charges,75% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,14.88,24,,,percent of total billed charges,24% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,49.6,80,,,percent of total billed charges,80% of total billed charges ,15.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,15.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.65,26.86,,,percent of total billed charges,26.86% of total billed charges,14.88,24,,,percent of total billed charges,24% of total billed charges ,19.34,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,14.88,24,,,percent of total billed charges,24% of total billed charges ,14.88,24,,,percent of total billed charges,24% of total billed charges ,14.88,49.6,
ZZZHYDROGEL 3OZ(88.7ML) TUBE,7000998,CDM,250,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
MAXIPIME (CEFEPIME) 1GM INJ,7001006,CDM,636,RC,J0692,HCPCS,Outpatient,,,44.5,22.25,,11.95,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.6,80,,,percent of total billed charges,80% of total billed charges ,10.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,10.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.95,26.86,,,percent of total billed charges,26.86% of total billed charges,10.68,24,,,percent of total billed charges,24% of total billed charges ,13.88,31.2,,,percent of total billed charges,31.2% of total billed charges,35.6,80,,,percent of total billed charges,80% of total billed charges,10.68,24,,,percent of total billed charges,24% of total billed charges ,10.68,24,,,percent of total billed charges,24% of total billed charges ,10.68,35.6,
ZZZRENAGEL (SEVELAMER HCL) 400MG TAB,7001013,CDM,250,RC,,,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
ZZZNULOJIX 250MG INJ,7001028,CDM,636,RC,J0485,HCPCS,Outpatient,,,4553.5,2276.75,,3.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1092.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3642.8,80,,,percent of total billed charges,80% of total billed charges ,1103.77,24.24,,,percent of total billed charges,24.24% of total billed charges ,2294.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,3415.13,75,,,percent of total billed charges,75% of total billed charges ,1114.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,1092.84,24,,,percent of total billed charges,24% of total billed charges ,1420.69,31.2,,,percent of total billed charges,31.2% of total billed charges,3642.8,80,,,percent of total billed charges,80% of total billed charges,1092.84,24,,,percent of total billed charges,24% of total billed charges ,1092.84,24,,,percent of total billed charges,24% of total billed charges ,3.87,3642.8,
"HEPARIN 25,000UNIT/0.45% NS 500ML DRIP",7001093,CDM,636,RC,J1644,HCPCS,Outpatient,,,70,35,,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56,80,,,percent of total billed charges,80% of total billed charges ,16.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,17.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.8,24,,,percent of total billed charges,24% of total billed charges ,21.84,31.2,,,percent of total billed charges,31.2% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,16.8,24,,,percent of total billed charges,24% of total billed charges ,16.8,24,,,percent of total billed charges,24% of total billed charges ,0.27,56,
"ZZZPANCREAS(PANCRELIP)12,000 UNITS CAP",7001127,CDM,250,RC,,,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
ZZZALPHA-PROTEINASE INHIB (HUMAN 1223MG,7001129,CDM,636,RC,J0256,HCPCS,Outpatient,,,2106.5,1053.25,,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,505.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1685.2,80,,,percent of total billed charges,80% of total billed charges ,510.62,24.24,,,percent of total billed charges,24.24% of total billed charges ,1061.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,1579.88,75,,,percent of total billed charges,75% of total billed charges ,515.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,505.56,24,,,percent of total billed charges,24% of total billed charges ,657.23,31.2,,,percent of total billed charges,31.2% of total billed charges,1685.2,80,,,percent of total billed charges,80% of total billed charges,505.56,24,,,percent of total billed charges,24% of total billed charges ,505.56,24,,,percent of total billed charges,24% of total billed charges ,4.88,1685.2,
INSULIN-70/30 (HUMULIN 70/30) VIAL,7001137,CDM,250,RC,,,Outpatient,,,1,0.5,,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.8,80,,,percent of total billed charges,80% of total billed charges ,0.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,0.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.31,31.2,,,percent of total billed charges,31.2% of total billed charges,0.8,80,,,percent of total billed charges,80% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,0.8,
DEXTROSE 5% + 0.2% SOD CHL 500ML IVPB,7001147,CDM,636,RC,J7040,HCPCS,Outpatient,,,42,21,,1.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.6,80,,,percent of total billed charges,80% of total billed charges ,10.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.08,24,,,percent of total billed charges,24% of total billed charges ,13.1,31.2,,,percent of total billed charges,31.2% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,1.35,33.6,
PROLIA 60MG/ML INJ,7001220,CDM,636,RC,J0897,HCPCS,Outpatient,,,7848.6,3924.3,,25.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1883.66,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6278.88,80,,,percent of total billed charges,80% of total billed charges ,1902.5,24.24,,,percent of total billed charges,24.24% of total billed charges ,3955.69,50.4,,,percent of total billed charges,50.4% of total billed charges ,5886.45,75,,,percent of total billed charges,75% of total billed charges ,1921.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,1883.66,24,,,percent of total billed charges,24% of total billed charges ,2448.76,31.2,,,percent of total billed charges,31.2% of total billed charges,6278.88,80,,,percent of total billed charges,80% of total billed charges,1883.66,24,,,percent of total billed charges,24% of total billed charges ,1883.66,24,,,percent of total billed charges,24% of total billed charges ,25.2,6278.88,
ZZZALPHA-PROTEINASE INHIB (HUMAN) 1177MG,7001224,CDM,636,RC,J0256,HCPCS,Outpatient,,,1,0.5,,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.8,80,,,percent of total billed charges,80% of total billed charges ,0.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,0.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.31,31.2,,,percent of total billed charges,31.2% of total billed charges,0.8,80,,,percent of total billed charges,80% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,4.88,
ZZZALPHA-PROTEINASE INHIB(HUMAN) 1177 MG,7001225,CDM,636,RC,J0256,HCPCS,Outpatient,,,2150.5,1075.25,,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,516.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1720.4,80,,,percent of total billed charges,80% of total billed charges ,521.28,24.24,,,percent of total billed charges,24.24% of total billed charges ,1083.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,1612.88,75,,,percent of total billed charges,75% of total billed charges ,526.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,516.12,24,,,percent of total billed charges,24% of total billed charges ,670.96,31.2,,,percent of total billed charges,31.2% of total billed charges,1720.4,80,,,percent of total billed charges,80% of total billed charges,516.12,24,,,percent of total billed charges,24% of total billed charges ,516.12,24,,,percent of total billed charges,24% of total billed charges ,4.88,1720.4,
ZZZNUBAIN (NALBUPHINE) 20MG/ML INJ,7001245,CDM,636,RC,J2300,HCPCS,Outpatient,,,47.5,23.75,,2.81,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.81,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,2.81,38,
PYRIDIUM (PHENAZOPYRID) 95MG TAB,7001273,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
VANCOMYCIN 125MG CAP,7001278,CDM,250,RC,,,Outpatient,,,161.5,80.75,,43.38,26.86,,,percent of total billed charges,26.86% of total billed charges,121.13,75,,,percent of total billed charges,75% of total billed charges ,121.13,75,,,percent of total billed charges,75% of total billed charges ,38.76,24,,,percent of total billed charges,24% of total billed charges ,121.13,75,,,percent of total billed charges,75% of total billed charges ,121.13,75,,,percent of total billed charges,75% of total billed charges ,129.2,80,,,percent of total billed charges,80% of total billed charges ,39.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,81.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,121.13,75,,,percent of total billed charges,75% of total billed charges ,39.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,43.38,26.86,,,percent of total billed charges,26.86% of total billed charges,38.76,24,,,percent of total billed charges,24% of total billed charges ,50.39,31.2,,,percent of total billed charges,31.2% of total billed charges,129.2,80,,,percent of total billed charges,80% of total billed charges,38.76,24,,,percent of total billed charges,24% of total billed charges ,38.76,24,,,percent of total billed charges,24% of total billed charges ,38.76,129.2,
ZZZALPHA-PROTEINASE INHIB (HUMAN) 1217,7001291,CDM,636,RC,J0256,HCPCS,Outpatient,,,1490.5,745.25,,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,357.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1192.4,80,,,percent of total billed charges,80% of total billed charges ,361.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,751.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,1117.88,75,,,percent of total billed charges,75% of total billed charges ,364.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,357.72,24,,,percent of total billed charges,24% of total billed charges ,465.04,31.2,,,percent of total billed charges,31.2% of total billed charges,1192.4,80,,,percent of total billed charges,80% of total billed charges,357.72,24,,,percent of total billed charges,24% of total billed charges ,357.72,24,,,percent of total billed charges,24% of total billed charges ,4.88,1192.4,
ENSURE STRAWBERRY 237ML BOTTLE,7001331,CDM,270,RC,,,Outpatient,,,22.5,11.25,,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,18,
ZZZALPHA-PROTEINASE INHIB (HUMAN) 1171MG,7001334,CDM,636,RC,J0256,HCPCS,Outpatient,,,2310.5,1155.25,,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,554.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1848.4,80,,,percent of total billed charges,80% of total billed charges ,560.07,24.24,,,percent of total billed charges,24.24% of total billed charges ,1164.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,1732.88,75,,,percent of total billed charges,75% of total billed charges ,565.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,554.52,24,,,percent of total billed charges,24% of total billed charges ,720.88,31.2,,,percent of total billed charges,31.2% of total billed charges,1848.4,80,,,percent of total billed charges,80% of total billed charges,554.52,24,,,percent of total billed charges,24% of total billed charges ,554.52,24,,,percent of total billed charges,24% of total billed charges ,4.88,1848.4,
ZZZALPHA-PROTEINASEINHIB(HUMAN)1183MG,7001335,CDM,636,RC,J0256,HCPCS,Outpatient,,,,,,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.88,4.88,
JANUVIA (SITAGLIPTIN) 50MG TABLET,7001361,CDM,259,RC,,,Outpatient,,,115,57.5,,30.89,26.86,,,percent of total billed charges,26.86% of total billed charges,86.25,75,,,percent of total billed charges,75% of total billed charges ,86.25,75,,,percent of total billed charges,75% of total billed charges ,27.6,24,,,percent of total billed charges,24% of total billed charges ,86.25,75,,,percent of total billed charges,75% of total billed charges ,86.25,75,,,percent of total billed charges,75% of total billed charges ,92,80,,,percent of total billed charges,80% of total billed charges ,27.88,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,86.25,75,,,percent of total billed charges,75% of total billed charges ,28.15,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.89,26.86,,,percent of total billed charges,26.86% of total billed charges,27.6,24,,,percent of total billed charges,24% of total billed charges ,35.88,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,27.6,24,,,percent of total billed charges,24% of total billed charges ,27.6,24,,,percent of total billed charges,24% of total billed charges ,27.6,92,
ENSURE VANILLA 237ML BOTTLE,7001362,CDM,270,RC,,,Outpatient,,,22.5,11.25,,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,18,
ENSURE CHOCOLATE 237ML BOTTLE,7001363,CDM,270,RC,,,Outpatient,,,22.5,11.25,,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,18,
TETRACAINE 0.5% OPTH SOLN,7001364,CDM,250,RC,,,Outpatient,,,70,35,,18.8,26.86,,,percent of total billed charges,26.86% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,16.8,24,,,percent of total billed charges,24% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,56,80,,,percent of total billed charges,80% of total billed charges ,16.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,17.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.8,26.86,,,percent of total billed charges,26.86% of total billed charges,16.8,24,,,percent of total billed charges,24% of total billed charges ,21.84,31.2,,,percent of total billed charges,31.2% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,16.8,24,,,percent of total billed charges,24% of total billed charges ,16.8,24,,,percent of total billed charges,24% of total billed charges ,16.8,56,
ZZZQUELICIN (SUCCINYL) 200MG/10ML INJ,7001365,CDM,636,RC,J0330,HCPCS,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ETOMIDATE 2MG/ML 10ML VIAL,7001366,CDM,636,RC,J3490,HCPCS,Outpatient,,,48.5,24.25,,13.03,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.8,80,,,percent of total billed charges,80% of total billed charges ,11.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.03,26.86,,,percent of total billed charges,26.86% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,15.13,31.2,,,percent of total billed charges,31.2% of total billed charges,38.8,80,,,percent of total billed charges,80% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,38.8,
DANTRIUM (DANTROLENE SOD) 20MG INJ,7001371,CDM,250,RC,,,Outpatient,,,2040.5,1020.25,,548.08,26.86,,,percent of total billed charges,26.86% of total billed charges,1530.38,75,,,percent of total billed charges,75% of total billed charges ,1530.38,75,,,percent of total billed charges,75% of total billed charges ,489.72,24,,,percent of total billed charges,24% of total billed charges ,1530.38,75,,,percent of total billed charges,75% of total billed charges ,1530.38,75,,,percent of total billed charges,75% of total billed charges ,1632.4,80,,,percent of total billed charges,80% of total billed charges ,494.62,24.24,,,percent of total billed charges,24.24% of total billed charges ,1028.41,50.4,,,percent of total billed charges,50.4% of total billed charges ,1530.38,75,,,percent of total billed charges,75% of total billed charges ,499.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,548.08,26.86,,,percent of total billed charges,26.86% of total billed charges,489.72,24,,,percent of total billed charges,24% of total billed charges ,636.64,31.2,,,percent of total billed charges,31.2% of total billed charges,1632.4,80,,,percent of total billed charges,80% of total billed charges,489.72,24,,,percent of total billed charges,24% of total billed charges ,489.72,24,,,percent of total billed charges,24% of total billed charges ,489.72,1632.4,
ZZZALPHA-PROTEINASE INHIB(HUMAN)1232MG,7001490,CDM,636,RC,J0256,HCPCS,Outpatient,,,2199,1099.5,,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,527.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1759.2,80,,,percent of total billed charges,80% of total billed charges ,533.04,24.24,,,percent of total billed charges,24.24% of total billed charges ,1108.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,1649.25,75,,,percent of total billed charges,75% of total billed charges ,538.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,527.76,24,,,percent of total billed charges,24% of total billed charges ,686.09,31.2,,,percent of total billed charges,31.2% of total billed charges,1759.2,80,,,percent of total billed charges,80% of total billed charges,527.76,24,,,percent of total billed charges,24% of total billed charges ,527.76,24,,,percent of total billed charges,24% of total billed charges ,4.88,1759.2,
ZZZFLUVOXAMINE 50MG TAB,7001518,CDM,250,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
HYDROCODONE/APAP 5-217MG/10ML,7001545,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
LITHIUM CARBONATE 150MG CAP,7001573,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZCOUMADIN (WARFARIN) 3MG TAB,7001607,CDM,259,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
BACITRACIN OINTMENT 0.9GM PKT,7001645,CDM,250,RC,,,Outpatient,,,12.5,6.25,,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.36,26.86,,,percent of total billed charges,26.86% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
VISTARIL (HYDROXYZ HCL) 25MG/ML IM,7001663,CDM,636,RC,J3410,HCPCS,Outpatient,,,127.5,63.75,,9.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,102,80,,,percent of total billed charges,80% of total billed charges ,30.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,64.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,31.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,30.6,24,,,percent of total billed charges,24% of total billed charges ,39.78,31.2,,,percent of total billed charges,31.2% of total billed charges,102,80,,,percent of total billed charges,80% of total billed charges,30.6,24,,,percent of total billed charges,24% of total billed charges ,30.6,24,,,percent of total billed charges,24% of total billed charges ,9.91,102,
EYE WASH 120ML,7001753,CDM,250,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
INFLUENZA VACCINE  HIGH-DOSE (17-18),7001758,CDM,636,RC,90662,HCPCS,Outpatient,,,243.47,121.74,,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.43,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,194.78,80,,,percent of total billed charges,80% of total billed charges ,59.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,122.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,182.6,75,,,percent of total billed charges,75% of total billed charges ,59.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,58.43,24,,,percent of total billed charges,24% of total billed charges ,75.96,31.2,,,percent of total billed charges,31.2% of total billed charges,194.78,80,,,percent of total billed charges,80% of total billed charges,58.43,24,,,percent of total billed charges,24% of total billed charges ,58.43,24,,,percent of total billed charges,24% of total billed charges ,58.43,194.78,
ZZZFLUZONE HI-DOSE 0.5ML 17-18,7001759,CDM,636,RC,90662,HCPCS,Outpatient,,,208,104,,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,166.4,80,,,percent of total billed charges,80% of total billed charges ,50.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,104.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,156,75,,,percent of total billed charges,75% of total billed charges ,50.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,49.92,24,,,percent of total billed charges,24% of total billed charges ,64.9,31.2,,,percent of total billed charges,31.2% of total billed charges,166.4,80,,,percent of total billed charges,80% of total billed charges,49.92,24,,,percent of total billed charges,24% of total billed charges ,49.92,24,,,percent of total billed charges,24% of total billed charges ,49.92,166.4,
ZZZFLUZONE QUAD0.5ML 2017-2018,7001760,CDM,636,RC,90686,HCPCS,Outpatient,,,114.5,57.25,,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,22.35,91.6,
ZZZALPHA-PROTEINASE INHIB (HUMAN) 1221,7001889,CDM,636,RC,J0256,HCPCS,Outpatient,,,2106.5,1053.25,,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,505.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1685.2,80,,,percent of total billed charges,80% of total billed charges ,510.62,24.24,,,percent of total billed charges,24.24% of total billed charges ,1061.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,1579.88,75,,,percent of total billed charges,75% of total billed charges ,515.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,505.56,24,,,percent of total billed charges,24% of total billed charges ,657.23,31.2,,,percent of total billed charges,31.2% of total billed charges,1685.2,80,,,percent of total billed charges,80% of total billed charges,505.56,24,,,percent of total billed charges,24% of total billed charges ,505.56,24,,,percent of total billed charges,24% of total billed charges ,4.88,1685.2,
ZZZALPHA-PROTEINASE INHIB (HUMAN) 1221MG,7001890,CDM,636,RC,J0256,HCPCS,Outpatient,,,2175.5,1087.75,,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,522.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1740.4,80,,,percent of total billed charges,80% of total billed charges ,527.34,24.24,,,percent of total billed charges,24.24% of total billed charges ,1096.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,1631.63,75,,,percent of total billed charges,75% of total billed charges ,532.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,522.12,24,,,percent of total billed charges,24% of total billed charges ,678.76,31.2,,,percent of total billed charges,31.2% of total billed charges,1740.4,80,,,percent of total billed charges,80% of total billed charges,522.12,24,,,percent of total billed charges,24% of total billed charges ,522.12,24,,,percent of total billed charges,24% of total billed charges ,4.88,1740.4,
ZZZZOMETA (ZOLEDRONIC ACID) 4MG/100ML,7001891,CDM,636,RC,J3489,HCPCS,Outpatient,,,896,448,,7.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,215.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,716.8,80,,,percent of total billed charges,80% of total billed charges ,217.19,24.24,,,percent of total billed charges,24.24% of total billed charges ,451.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,672,75,,,percent of total billed charges,75% of total billed charges ,219.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,215.04,24,,,percent of total billed charges,24% of total billed charges ,279.55,31.2,,,percent of total billed charges,31.2% of total billed charges,716.8,80,,,percent of total billed charges,80% of total billed charges,215.04,24,,,percent of total billed charges,24% of total billed charges ,215.04,24,,,percent of total billed charges,24% of total billed charges ,7.21,716.8,
ZZZTESTOSTERONE CYPIONATE INJ 200MG/ML,7001895,CDM,250,RC,J1071,HCPCS,Outpatient,,,61,30.5,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.75,75,,,percent of total billed charges,75% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,14.64,24,,,percent of total billed charges,24% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,48.8,80,,,percent of total billed charges,80% of total billed charges ,14.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,30.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,14.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.64,24,,,percent of total billed charges,24% of total billed charges ,19.03,31.2,,,percent of total billed charges,31.2% of total billed charges,48.8,80,,,percent of total billed charges,80% of total billed charges,14.64,24,,,percent of total billed charges,24% of total billed charges ,14.64,24,,,percent of total billed charges,24% of total billed charges ,0.03,48.8,
CREON 12000/38000/60000 CAP,7001980,CDM,250,RC,,,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
BICITRA (SOD CIT/CITRIC ACID 5ML),7002042,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZALPHA-PROTEINASE INHIB (HUMAN 1217MG,7002068,CDM,636,RC,J0256,HCPCS,Outpatient,,,2106.5,1053.25,,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,505.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1685.2,80,,,percent of total billed charges,80% of total billed charges ,510.62,24.24,,,percent of total billed charges,24.24% of total billed charges ,1061.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,1579.88,75,,,percent of total billed charges,75% of total billed charges ,515.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,505.56,24,,,percent of total billed charges,24% of total billed charges ,657.23,31.2,,,percent of total billed charges,31.2% of total billed charges,1685.2,80,,,percent of total billed charges,80% of total billed charges,505.56,24,,,percent of total billed charges,24% of total billed charges ,505.56,24,,,percent of total billed charges,24% of total billed charges ,4.88,1685.2,
ZZZALPHA-PROTEINASE INHIB (HUMAN) 1183MG,7002081,CDM,636,RC,J0256,HCPCS,Outpatient,,,2392.5,1196.25,,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,574.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1914,80,,,percent of total billed charges,80% of total billed charges ,579.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,1205.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,1794.38,75,,,percent of total billed charges,75% of total billed charges ,585.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,574.2,24,,,percent of total billed charges,24% of total billed charges ,746.46,31.2,,,percent of total billed charges,31.2% of total billed charges,1914,80,,,percent of total billed charges,80% of total billed charges,574.2,24,,,percent of total billed charges,24% of total billed charges ,574.2,24,,,percent of total billed charges,24% of total billed charges ,4.88,1914,
ZZZLEVEMIR (DETEMIR) 100 UNIT/ML PEN,7002082,CDM,250,RC,,,Outpatient,,,436.5,218.25,,117.24,26.86,,,percent of total billed charges,26.86% of total billed charges,327.38,75,,,percent of total billed charges,75% of total billed charges ,327.38,75,,,percent of total billed charges,75% of total billed charges ,104.76,24,,,percent of total billed charges,24% of total billed charges ,327.38,75,,,percent of total billed charges,75% of total billed charges ,327.38,75,,,percent of total billed charges,75% of total billed charges ,349.2,80,,,percent of total billed charges,80% of total billed charges ,105.81,24.24,,,percent of total billed charges,24.24% of total billed charges ,220,50.4,,,percent of total billed charges,50.4% of total billed charges ,327.38,75,,,percent of total billed charges,75% of total billed charges ,106.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,117.24,26.86,,,percent of total billed charges,26.86% of total billed charges,104.76,24,,,percent of total billed charges,24% of total billed charges ,136.19,31.2,,,percent of total billed charges,31.2% of total billed charges,349.2,80,,,percent of total billed charges,80% of total billed charges,104.76,24,,,percent of total billed charges,24% of total billed charges ,104.76,24,,,percent of total billed charges,24% of total billed charges ,104.76,349.2,
CORTISPORIN ( B/NEO/POLY/HC) OP SUSP,7002114,CDM,250,RC,,,Outpatient,,,713,356.5,,191.51,26.86,,,percent of total billed charges,26.86% of total billed charges,534.75,75,,,percent of total billed charges,75% of total billed charges ,534.75,75,,,percent of total billed charges,75% of total billed charges ,171.12,24,,,percent of total billed charges,24% of total billed charges ,534.75,75,,,percent of total billed charges,75% of total billed charges ,534.75,75,,,percent of total billed charges,75% of total billed charges ,570.4,80,,,percent of total billed charges,80% of total billed charges ,172.83,24.24,,,percent of total billed charges,24.24% of total billed charges ,359.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,534.75,75,,,percent of total billed charges,75% of total billed charges ,174.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,191.51,26.86,,,percent of total billed charges,26.86% of total billed charges,171.12,24,,,percent of total billed charges,24% of total billed charges ,222.46,31.2,,,percent of total billed charges,31.2% of total billed charges,570.4,80,,,percent of total billed charges,80% of total billed charges,171.12,24,,,percent of total billed charges,24% of total billed charges ,171.12,24,,,percent of total billed charges,24% of total billed charges ,171.12,570.4,
INSULIN-RAPID (HUMALOG) PEN,7002159,CDM,636,RC,J1817,HCPCS,Outpatient,,,183,91.5,,49.15,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,43.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,146.4,80,,,percent of total billed charges,80% of total billed charges ,44.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,92.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,137.25,75,,,percent of total billed charges,75% of total billed charges ,44.8,24.48,,,percent of total billed charges,24.48% of total billed charges ,49.15,26.86,,,percent of total billed charges,26.86% of total billed charges,43.92,24,,,percent of total billed charges,24% of total billed charges ,57.1,31.2,,,percent of total billed charges,31.2% of total billed charges,146.4,80,,,percent of total billed charges,80% of total billed charges,43.92,24,,,percent of total billed charges,24% of total billed charges ,43.92,24,,,percent of total billed charges,24% of total billed charges ,43.92,146.4,
MORPHINE SUL 4MG IM / IV,7002221,CDM,636,RC,J2270,HCPCS,Outpatient,,,26,13,,4.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,4.67,20.8,
SINEMET (CARB/LEVOD) 25/250MG,7002227,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZTRUVADA (TENOFOV / EMTRIC 300/200)TAB,7002241,CDM,250,RC,,,Outpatient,,,331.5,165.75,,89.04,26.86,,,percent of total billed charges,26.86% of total billed charges,248.63,75,,,percent of total billed charges,75% of total billed charges ,248.63,75,,,percent of total billed charges,75% of total billed charges ,79.56,24,,,percent of total billed charges,24% of total billed charges ,248.63,75,,,percent of total billed charges,75% of total billed charges ,248.63,75,,,percent of total billed charges,75% of total billed charges ,265.2,80,,,percent of total billed charges,80% of total billed charges ,80.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,167.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,248.63,75,,,percent of total billed charges,75% of total billed charges ,81.15,24.48,,,percent of total billed charges,24.48% of total billed charges ,89.04,26.86,,,percent of total billed charges,26.86% of total billed charges,79.56,24,,,percent of total billed charges,24% of total billed charges ,103.43,31.2,,,percent of total billed charges,31.2% of total billed charges,265.2,80,,,percent of total billed charges,80% of total billed charges,79.56,24,,,percent of total billed charges,24% of total billed charges ,79.56,24,,,percent of total billed charges,24% of total billed charges ,79.56,265.2,
ZZZISENTRESS (RALTEGRAVIR) 400MG,7002242,CDM,250,RC,,,Outpatient,,,156.5,78.25,,42.04,26.86,,,percent of total billed charges,26.86% of total billed charges,117.38,75,,,percent of total billed charges,75% of total billed charges ,117.38,75,,,percent of total billed charges,75% of total billed charges ,37.56,24,,,percent of total billed charges,24% of total billed charges ,117.38,75,,,percent of total billed charges,75% of total billed charges ,117.38,75,,,percent of total billed charges,75% of total billed charges ,125.2,80,,,percent of total billed charges,80% of total billed charges ,37.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,78.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,117.38,75,,,percent of total billed charges,75% of total billed charges ,38.31,24.48,,,percent of total billed charges,24.48% of total billed charges ,42.04,26.86,,,percent of total billed charges,26.86% of total billed charges,37.56,24,,,percent of total billed charges,24% of total billed charges ,48.83,31.2,,,percent of total billed charges,31.2% of total billed charges,125.2,80,,,percent of total billed charges,80% of total billed charges,37.56,24,,,percent of total billed charges,24% of total billed charges ,37.56,24,,,percent of total billed charges,24% of total billed charges ,37.56,125.2,
ZZZFLUZONE QUAD 0.5ML 2018-2019,7002255,CDM,636,RC,90686,HCPCS,Outpatient,,,114.5,57.25,,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,22.35,91.6,
ZZZFLUZONE HI-DOSE 0.5ML 18-19,7002256,CDM,636,RC,90662,HCPCS,Outpatient,,,212,106,,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,50.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,169.6,80,,,percent of total billed charges,80% of total billed charges ,51.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,106.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,51.9,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,50.88,24,,,percent of total billed charges,24% of total billed charges ,66.14,31.2,,,percent of total billed charges,31.2% of total billed charges,169.6,80,,,percent of total billed charges,80% of total billed charges,50.88,24,,,percent of total billed charges,24% of total billed charges ,50.88,24,,,percent of total billed charges,24% of total billed charges ,50.88,169.6,
HEPATITIS B IMMU GLOBUL 312U/ML 5ML VIAL,7002261,CDM,636,RC,J1573,HCPCS,Outpatient,,,3236.5,1618.25,,869.32,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,776.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2589.2,80,,,percent of total billed charges,80% of total billed charges ,784.53,24.24,,,percent of total billed charges,24.24% of total billed charges ,1631.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,2427.38,75,,,percent of total billed charges,75% of total billed charges ,792.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,869.32,26.86,,,percent of total billed charges,26.86% of total billed charges,776.76,24,,,percent of total billed charges,24% of total billed charges ,1009.79,31.2,,,percent of total billed charges,31.2% of total billed charges,2589.2,80,,,percent of total billed charges,80% of total billed charges,776.76,24,,,percent of total billed charges,24% of total billed charges ,776.76,24,,,percent of total billed charges,24% of total billed charges ,776.76,2589.2,
PROTAMINE 10MG/1ML INJ (25ML),7002284,CDM,636,RC,J2720,HCPCS,Outpatient,,,262,131,,1.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,209.6,80,,,percent of total billed charges,80% of total billed charges ,63.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,132.05,50.4,,,percent of total billed charges,50.4% of total billed charges ,196.5,75,,,percent of total billed charges,75% of total billed charges ,64.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.88,24,,,percent of total billed charges,24% of total billed charges ,81.74,31.2,,,percent of total billed charges,31.2% of total billed charges,209.6,80,,,percent of total billed charges,80% of total billed charges,62.88,24,,,percent of total billed charges,24% of total billed charges ,62.88,24,,,percent of total billed charges,24% of total billed charges ,1.66,209.6,
DILANTIN (PHENYTOIN) 250MG/5ML INJECT,7002291,CDM,636,RC,J1165,HCPCS,Outpatient,,,18.5,9.25,,0.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,0.63,14.8,
METHYLENE BLUE 0.5% 50MG/10ML AMP,7002385,CDM,636,RC,Q9968,HCPCS,Outpatient,,,926,463,,248.72,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,222.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,740.8,80,,,percent of total billed charges,80% of total billed charges ,224.46,24.24,,,percent of total billed charges,24.24% of total billed charges ,466.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,694.5,75,,,percent of total billed charges,75% of total billed charges ,226.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,248.72,26.86,,,percent of total billed charges,26.86% of total billed charges,222.24,24,,,percent of total billed charges,24% of total billed charges ,288.91,31.2,,,percent of total billed charges,31.2% of total billed charges,740.8,80,,,percent of total billed charges,80% of total billed charges,222.24,24,,,percent of total billed charges,24% of total billed charges ,222.24,24,,,percent of total billed charges,24% of total billed charges ,222.24,740.8,
DEPO-MEDROL (METHYLPRED) 40MG INJ,7002550,CDM,636,RC,J1030,HCPCS,Outpatient,,,77.5,38.75,,6.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62,80,,,percent of total billed charges,80% of total billed charges ,18.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,18.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.6,24,,,percent of total billed charges,24% of total billed charges ,24.18,31.2,,,percent of total billed charges,31.2% of total billed charges,62,80,,,percent of total billed charges,80% of total billed charges,18.6,24,,,percent of total billed charges,24% of total billed charges ,18.6,24,,,percent of total billed charges,24% of total billed charges ,6.42,62,
SOLU-MEDROL (METHYLPRED) 1GRAM,7002553,CDM,636,RC,J2919,HCPCS,Outpatient,,,252.5,126.25,,67.82,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,202,80,,,percent of total billed charges,80% of total billed charges ,61.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,127.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,189.38,75,,,percent of total billed charges,75% of total billed charges ,61.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,67.82,26.86,,,percent of total billed charges,26.86% of total billed charges,60.6,24,,,percent of total billed charges,24% of total billed charges ,78.78,31.2,,,percent of total billed charges,31.2% of total billed charges,202,80,,,percent of total billed charges,80% of total billed charges,60.6,24,,,percent of total billed charges,24% of total billed charges ,60.6,24,,,percent of total billed charges,24% of total billed charges ,60.6,202,
INJECTAFER 750MG/15ML (50MG/ML),7002592,CDM,636,RC,J1439,HCPCS,Outpatient,,,6540.3,3270.15,,1.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1569.67,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5232.24,80,,,percent of total billed charges,80% of total billed charges ,1585.37,24.24,,,percent of total billed charges,24.24% of total billed charges ,3296.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,4905.23,75,,,percent of total billed charges,75% of total billed charges ,1601.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,1569.67,24,,,percent of total billed charges,24% of total billed charges ,2040.57,31.2,,,percent of total billed charges,31.2% of total billed charges,5232.24,80,,,percent of total billed charges,80% of total billed charges,1569.67,24,,,percent of total billed charges,24% of total billed charges ,1569.67,24,,,percent of total billed charges,24% of total billed charges ,1.15,5232.24,
BUMEX (BUMETANIDE) 0.25MG/ML 10ML INJECT,7002595,CDM,250,RC,,,Outpatient,,,28,14,,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,22.4,80,,,percent of total billed charges,80% of total billed charges ,6.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,8.74,31.2,,,percent of total billed charges,31.2% of total billed charges,22.4,80,,,percent of total billed charges,80% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,22.4,
ELIQUIS (APIXABAN) 5MG TABLET,7002671,CDM,250,RC,,,Outpatient,,,65,32.5,,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,52,80,,,percent of total billed charges,80% of total billed charges ,15.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,15.6,24,,,percent of total billed charges,24% of total billed charges ,20.28,31.2,,,percent of total billed charges,31.2% of total billed charges,52,80,,,percent of total billed charges,80% of total billed charges,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,52,
BRETHINE (TERBUTALINE) 2.5MG TAB,7002834,CDM,250,RC,,,Outpatient,,,35,17.5,,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,28,80,,,percent of total billed charges,80% of total billed charges ,8.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,10.92,31.2,,,percent of total billed charges,31.2% of total billed charges,28,80,,,percent of total billed charges,80% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,28,
ZZZPENTAMIDINE ISETHIONATE 300MG VIAL,7002849,CDM,636,RC,J2545,HCPCS,Outpatient,,,754,377,,202.52,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,180.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,603.2,80,,,percent of total billed charges,80% of total billed charges ,182.77,24.24,,,percent of total billed charges,24.24% of total billed charges ,380.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,565.5,75,,,percent of total billed charges,75% of total billed charges ,184.58,24.48,,,percent of total billed charges,24.48% of total billed charges ,202.52,26.86,,,percent of total billed charges,26.86% of total billed charges,180.96,24,,,percent of total billed charges,24% of total billed charges ,235.25,31.2,,,percent of total billed charges,31.2% of total billed charges,603.2,80,,,percent of total billed charges,80% of total billed charges,180.96,24,,,percent of total billed charges,24% of total billed charges ,180.96,24,,,percent of total billed charges,24% of total billed charges ,180.96,603.2,
JEVITY 1.2   240ML,7002864,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
MAG SULFATE/ WATER IVPB  4GM/100ML PREMI,7002878,CDM,636,RC,J3475,HCPCS,Outpatient,,,64,32,,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,0.69,51.2,
"ZZZHEPARIN 12,500UNIT/0.45% NS 250ML",7002970,CDM,636,RC,J1644,HCPCS,Outpatient,,,54.5,27.25,,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,43.6,80,,,percent of total billed charges,80% of total billed charges ,13.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,27.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,13.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.08,24,,,percent of total billed charges,24% of total billed charges ,17,31.2,,,percent of total billed charges,31.2% of total billed charges,43.6,80,,,percent of total billed charges,80% of total billed charges,13.08,24,,,percent of total billed charges,24% of total billed charges ,13.08,24,,,percent of total billed charges,24% of total billed charges ,0.27,43.6,
ZZZFLUZONE QUAD  0.5ML 2019-2020,7002985,CDM,636,RC,90686,HCPCS,Outpatient,,,116.5,58.25,,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,93.2,80,,,percent of total billed charges,80% of total billed charges ,28.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,58.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,28.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.96,24,,,percent of total billed charges,24% of total billed charges ,36.35,31.2,,,percent of total billed charges,31.2% of total billed charges,93.2,80,,,percent of total billed charges,80% of total billed charges,27.96,24,,,percent of total billed charges,24% of total billed charges ,27.96,24,,,percent of total billed charges,24% of total billed charges ,22.35,93.2,
ZZZFLUZONE HI-DOSE (0.5ML 19-20,7002986,CDM,636,RC,90662,HCPCS,Outpatient,,,293.5,146.75,,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,70.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,234.8,80,,,percent of total billed charges,80% of total billed charges ,71.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,147.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,220.13,75,,,percent of total billed charges,75% of total billed charges ,71.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,70.44,24,,,percent of total billed charges,24% of total billed charges ,91.57,31.2,,,percent of total billed charges,31.2% of total billed charges,234.8,80,,,percent of total billed charges,80% of total billed charges,70.44,24,,,percent of total billed charges,24% of total billed charges ,70.44,24,,,percent of total billed charges,24% of total billed charges ,70.44,234.8,
ZZZZOVIRAX (ACYCLOVIR) 5% OINTMENT 15G,7002999,CDM,250,RC,,,Outpatient,,,584,292,,156.86,26.86,,,percent of total billed charges,26.86% of total billed charges,438,75,,,percent of total billed charges,75% of total billed charges ,438,75,,,percent of total billed charges,75% of total billed charges ,140.16,24,,,percent of total billed charges,24% of total billed charges ,438,75,,,percent of total billed charges,75% of total billed charges ,438,75,,,percent of total billed charges,75% of total billed charges ,467.2,80,,,percent of total billed charges,80% of total billed charges ,141.56,24.24,,,percent of total billed charges,24.24% of total billed charges ,294.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,438,75,,,percent of total billed charges,75% of total billed charges ,142.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,156.86,26.86,,,percent of total billed charges,26.86% of total billed charges,140.16,24,,,percent of total billed charges,24% of total billed charges ,182.21,31.2,,,percent of total billed charges,31.2% of total billed charges,467.2,80,,,percent of total billed charges,80% of total billed charges,140.16,24,,,percent of total billed charges,24% of total billed charges ,140.16,24,,,percent of total billed charges,24% of total billed charges ,140.16,467.2,
INFLECTRA (INFLIXIMAB-DYYB) 100MG VIAL,7003013,CDM,636,RC,Q5103,HCPCS,Outpatient,,,4553.5,2276.75,,1223.07,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1092.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3642.8,80,,,percent of total billed charges,80% of total billed charges ,1103.77,24.24,,,percent of total billed charges,24.24% of total billed charges ,2294.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,3415.13,75,,,percent of total billed charges,75% of total billed charges ,1114.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,1223.07,26.86,,,percent of total billed charges,26.86% of total billed charges,1092.84,24,,,percent of total billed charges,24% of total billed charges ,1420.69,31.2,,,percent of total billed charges,31.2% of total billed charges,3642.8,80,,,percent of total billed charges,80% of total billed charges,1092.84,24,,,percent of total billed charges,24% of total billed charges ,1092.84,24,,,percent of total billed charges,24% of total billed charges ,1092.84,3642.8,
ZZZMAXIPIME (CEFEPIME) 2GM INJ,7003170,CDM,636,RC,J0692,HCPCS,Outpatient,,,68,34,,18.26,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.4,80,,,percent of total billed charges,80% of total billed charges ,16.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,16.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.26,26.86,,,percent of total billed charges,26.86% of total billed charges,16.32,24,,,percent of total billed charges,24% of total billed charges ,21.22,31.2,,,percent of total billed charges,31.2% of total billed charges,54.4,80,,,percent of total billed charges,80% of total billed charges,16.32,24,,,percent of total billed charges,24% of total billed charges ,16.32,24,,,percent of total billed charges,24% of total billed charges ,16.32,54.4,
MAG SULFATE/ WATER IVPB  2GM/50ML PREMIX,7003246,CDM,636,RC,J3475,HCPCS,Outpatient,,,96,48,,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,0.69,76.8,
BOTOX 100U THPTC,7003285,CDM,636,RC,J0585,HCPCS,Outpatient,,,2973.5,1486.75,,6.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,713.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2378.8,80,,,percent of total billed charges,80% of total billed charges ,720.78,24.24,,,percent of total billed charges,24.24% of total billed charges ,1498.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,2230.13,75,,,percent of total billed charges,75% of total billed charges ,727.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,713.64,24,,,percent of total billed charges,24% of total billed charges ,927.73,31.2,,,percent of total billed charges,31.2% of total billed charges,2378.8,80,,,percent of total billed charges,80% of total billed charges,713.64,24,,,percent of total billed charges,24% of total billed charges ,713.64,24,,,percent of total billed charges,24% of total billed charges ,6.33,2378.8,
MIDODRINE 5MG TAB,7003304,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
TAMIFLU 6MG/ML 60ML SUSP,7003311,CDM,250,RC,,,Outpatient,,,723,361.5,,194.2,26.86,,,percent of total billed charges,26.86% of total billed charges,542.25,75,,,percent of total billed charges,75% of total billed charges ,542.25,75,,,percent of total billed charges,75% of total billed charges ,173.52,24,,,percent of total billed charges,24% of total billed charges ,542.25,75,,,percent of total billed charges,75% of total billed charges ,542.25,75,,,percent of total billed charges,75% of total billed charges ,578.4,80,,,percent of total billed charges,80% of total billed charges ,175.26,24.24,,,percent of total billed charges,24.24% of total billed charges ,364.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,542.25,75,,,percent of total billed charges,75% of total billed charges ,176.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,194.2,26.86,,,percent of total billed charges,26.86% of total billed charges,173.52,24,,,percent of total billed charges,24% of total billed charges ,225.58,31.2,,,percent of total billed charges,31.2% of total billed charges,578.4,80,,,percent of total billed charges,80% of total billed charges,173.52,24,,,percent of total billed charges,24% of total billed charges ,173.52,24,,,percent of total billed charges,24% of total billed charges ,173.52,578.4,
INSULIN-70/30 (HUMULIN 70/30) PEN,7003347,CDM,250,RC,,,Outpatient,,,175,87.5,,47.01,26.86,,,percent of total billed charges,26.86% of total billed charges,131.25,75,,,percent of total billed charges,75% of total billed charges ,131.25,75,,,percent of total billed charges,75% of total billed charges ,42,24,,,percent of total billed charges,24% of total billed charges ,131.25,75,,,percent of total billed charges,75% of total billed charges ,131.25,75,,,percent of total billed charges,75% of total billed charges ,140,80,,,percent of total billed charges,80% of total billed charges ,42.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,88.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,131.25,75,,,percent of total billed charges,75% of total billed charges ,42.84,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.01,26.86,,,percent of total billed charges,26.86% of total billed charges,42,24,,,percent of total billed charges,24% of total billed charges ,54.6,31.2,,,percent of total billed charges,31.2% of total billed charges,140,80,,,percent of total billed charges,80% of total billed charges,42,24,,,percent of total billed charges,24% of total billed charges ,42,24,,,percent of total billed charges,24% of total billed charges ,42,140,
SOTRADECOL 1% IV,7003383,CDM,250,RC,J3490,HCPCS,Outpatient,,,459.5,229.75,,123.42,26.86,,,percent of total billed charges,26.86% of total billed charges,344.63,75,,,percent of total billed charges,75% of total billed charges ,344.63,75,,,percent of total billed charges,75% of total billed charges ,110.28,24,,,percent of total billed charges,24% of total billed charges ,344.63,75,,,percent of total billed charges,75% of total billed charges ,344.63,75,,,percent of total billed charges,75% of total billed charges ,367.6,80,,,percent of total billed charges,80% of total billed charges ,111.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,231.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,344.63,75,,,percent of total billed charges,75% of total billed charges ,112.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,123.42,26.86,,,percent of total billed charges,26.86% of total billed charges,110.28,24,,,percent of total billed charges,24% of total billed charges ,143.36,31.2,,,percent of total billed charges,31.2% of total billed charges,367.6,80,,,percent of total billed charges,80% of total billed charges,110.28,24,,,percent of total billed charges,24% of total billed charges ,110.28,24,,,percent of total billed charges,24% of total billed charges ,110.28,367.6,
TRIAMCINOLONE ACETONIDE 0.5% CREAM,7003397,CDM,250,RC,,,Outpatient,,,66,33,,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,52.8,80,,,percent of total billed charges,80% of total billed charges ,16,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,16.16,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,20.59,31.2,,,percent of total billed charges,31.2% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,52.8,
PREMARIN 25MG INJ,7003403,CDM,636,RC,J1410,HCPCS,Outpatient,,,1523.5,761.75,,372.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,365.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1218.8,80,,,percent of total billed charges,80% of total billed charges ,369.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,767.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,1142.63,75,,,percent of total billed charges,75% of total billed charges ,372.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,372.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,365.64,24,,,percent of total billed charges,24% of total billed charges ,475.33,31.2,,,percent of total billed charges,31.2% of total billed charges,1218.8,80,,,percent of total billed charges,80% of total billed charges,365.64,24,,,percent of total billed charges,24% of total billed charges ,365.64,24,,,percent of total billed charges,24% of total billed charges ,365.64,1218.8,
EVACUATED CONTAINER,7003414,CDM,250,RC,,,Outpatient,,,107,53.5,,28.74,26.86,,,percent of total billed charges,26.86% of total billed charges,80.25,75,,,percent of total billed charges,75% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,25.68,24,,,percent of total billed charges,24% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,85.6,80,,,percent of total billed charges,80% of total billed charges ,25.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,53.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,80.25,75,,,percent of total billed charges,75% of total billed charges ,26.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.74,26.86,,,percent of total billed charges,26.86% of total billed charges,25.68,24,,,percent of total billed charges,24% of total billed charges ,33.38,31.2,,,percent of total billed charges,31.2% of total billed charges,85.6,80,,,percent of total billed charges,80% of total billed charges,25.68,24,,,percent of total billed charges,24% of total billed charges ,25.68,24,,,percent of total billed charges,24% of total billed charges ,25.68,85.6,
ZZZSILVADENE (SILVER SULFA) 1% 25GM,7003417,CDM,250,RC,,,Outpatient,,,56.5,28.25,,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
ASMANEX TWISTHALER 220MCG,7003423,CDM,250,RC,,,Outpatient,,,435.5,217.75,,116.98,26.86,,,percent of total billed charges,26.86% of total billed charges,326.63,75,,,percent of total billed charges,75% of total billed charges ,326.63,75,,,percent of total billed charges,75% of total billed charges ,104.52,24,,,percent of total billed charges,24% of total billed charges ,326.63,75,,,percent of total billed charges,75% of total billed charges ,326.63,75,,,percent of total billed charges,75% of total billed charges ,348.4,80,,,percent of total billed charges,80% of total billed charges ,105.57,24.24,,,percent of total billed charges,24.24% of total billed charges ,219.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,326.63,75,,,percent of total billed charges,75% of total billed charges ,106.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,116.98,26.86,,,percent of total billed charges,26.86% of total billed charges,104.52,24,,,percent of total billed charges,24% of total billed charges ,135.88,31.2,,,percent of total billed charges,31.2% of total billed charges,348.4,80,,,percent of total billed charges,80% of total billed charges,104.52,24,,,percent of total billed charges,24% of total billed charges ,104.52,24,,,percent of total billed charges,24% of total billed charges ,104.52,348.4,
MELATONIN 5MG TABLET,7003475,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
LINZESS 72MCG CAPSULE,7003503,CDM,250,RC,,,Outpatient,,,109,54.5,,29.28,26.86,,,percent of total billed charges,26.86% of total billed charges,81.75,75,,,percent of total billed charges,75% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,26.16,24,,,percent of total billed charges,24% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,87.2,80,,,percent of total billed charges,80% of total billed charges ,26.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,26.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.28,26.86,,,percent of total billed charges,26.86% of total billed charges,26.16,24,,,percent of total billed charges,24% of total billed charges ,34.01,31.2,,,percent of total billed charges,31.2% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,26.16,24,,,percent of total billed charges,24% of total billed charges ,26.16,24,,,percent of total billed charges,24% of total billed charges ,26.16,87.2,
AMITIZA (LUBIPROSTONE) 8MCG CAPSULE,7003504,CDM,250,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
AMPICILLIN 2GM INJ,7003569,CDM,636,RC,J0290,HCPCS,Outpatient,,,75,37.5,,1.01,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60,80,,,percent of total billed charges,80% of total billed charges ,18.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,18.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.01,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18,24,,,percent of total billed charges,24% of total billed charges ,23.4,31.2,,,percent of total billed charges,31.2% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,18,24,,,percent of total billed charges,24% of total billed charges ,18,24,,,percent of total billed charges,24% of total billed charges ,1.01,60,
ZZZALGINATE SILVER (MAXORB EXTRA AG+),7003591,CDM,250,RC,,,Outpatient,,,93.5,46.75,,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,74.8,80,,,percent of total billed charges,80% of total billed charges ,22.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,70.13,75,,,percent of total billed charges,75% of total billed charges ,22.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.11,26.86,,,percent of total billed charges,26.86% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,29.17,31.2,,,percent of total billed charges,31.2% of total billed charges,74.8,80,,,percent of total billed charges,80% of total billed charges,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,24,,,percent of total billed charges,24% of total billed charges ,22.44,74.8,
VITAMIN D3 5000 IU (125MCG) TAB,7003599,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ACETYLCYSTEINE 600MG CAPSULE,7003600,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
"PROCRIT (EPOETIN ALPH) 2,000 UNIT/ML VL",7003611,CDM,636,RC,J0885,HCPCS,Outpatient,,,318.5,159.25,,8.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,254.8,80,,,percent of total billed charges,80% of total billed charges ,77.2,24.24,,,percent of total billed charges,24.24% of total billed charges ,160.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,77.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,76.44,24,,,percent of total billed charges,24% of total billed charges ,99.37,31.2,,,percent of total billed charges,31.2% of total billed charges,254.8,80,,,percent of total billed charges,80% of total billed charges,76.44,24,,,percent of total billed charges,24% of total billed charges ,76.44,24,,,percent of total billed charges,24% of total billed charges ,8.89,254.8,
"GI COCKTAIL(MAALOX,LEVSIN,XYLO VIS)",7003644,CDM,636,RC,J1980,HCPCS,Outpatient,,,47.5,23.75,,35.46,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.46,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
ZZZREMDESIVIR 100MG/VIAL,7003647,CDM,636,RC,J0248,HCPCS,Outpatient,,,2111.5,1055.75,,6.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,506.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1689.2,80,,,percent of total billed charges,80% of total billed charges ,511.83,24.24,,,percent of total billed charges,24.24% of total billed charges ,1064.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,1583.63,75,,,percent of total billed charges,75% of total billed charges ,516.9,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,506.76,24,,,percent of total billed charges,24% of total billed charges ,658.79,31.2,,,percent of total billed charges,31.2% of total billed charges,1689.2,80,,,percent of total billed charges,80% of total billed charges,506.76,24,,,percent of total billed charges,24% of total billed charges ,506.76,24,,,percent of total billed charges,24% of total billed charges ,6.06,1689.2,
TINACTIN CREAM 1%,7003652,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
KEPPRA(LEVETIRACETAM) 500MG/5ML ORAL SOL,7003660,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
PULMICORT FLEXHALER 90MCG,7003665,CDM,250,RC,,,Outpatient,,,921,460.5,,247.38,26.86,,,percent of total billed charges,26.86% of total billed charges,690.75,75,,,percent of total billed charges,75% of total billed charges ,690.75,75,,,percent of total billed charges,75% of total billed charges ,221.04,24,,,percent of total billed charges,24% of total billed charges ,690.75,75,,,percent of total billed charges,75% of total billed charges ,690.75,75,,,percent of total billed charges,75% of total billed charges ,736.8,80,,,percent of total billed charges,80% of total billed charges ,223.25,24.24,,,percent of total billed charges,24.24% of total billed charges ,464.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,690.75,75,,,percent of total billed charges,75% of total billed charges ,225.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,247.38,26.86,,,percent of total billed charges,26.86% of total billed charges,221.04,24,,,percent of total billed charges,24% of total billed charges ,287.35,31.2,,,percent of total billed charges,31.2% of total billed charges,736.8,80,,,percent of total billed charges,80% of total billed charges,221.04,24,,,percent of total billed charges,24% of total billed charges ,221.04,24,,,percent of total billed charges,24% of total billed charges ,221.04,736.8,
ZZZFLUZONE HI-DOSE (INFLU(=) 0.7ML 20-21,7003683,CDM,636,RC,90662,HCPCS,Outpatient,,,318.5,159.25,,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,254.8,80,,,percent of total billed charges,80% of total billed charges ,77.2,24.24,,,percent of total billed charges,24.24% of total billed charges ,160.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,238.88,75,,,percent of total billed charges,75% of total billed charges ,77.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,76.44,24,,,percent of total billed charges,24% of total billed charges ,99.37,31.2,,,percent of total billed charges,31.2% of total billed charges,254.8,80,,,percent of total billed charges,80% of total billed charges,76.44,24,,,percent of total billed charges,24% of total billed charges ,76.44,24,,,percent of total billed charges,24% of total billed charges ,73.4,254.8,
ZZZFLUZONE QUAD  0.5ML 2020-2021,7003684,CDM,636,RC,90686,HCPCS,Outpatient,,,115.5,57.75,,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,92.4,80,,,percent of total billed charges,80% of total billed charges ,28,24.24,,,percent of total billed charges,24.24% of total billed charges ,58.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,86.63,75,,,percent of total billed charges,75% of total billed charges ,28.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.72,24,,,percent of total billed charges,24% of total billed charges ,36.04,31.2,,,percent of total billed charges,31.2% of total billed charges,92.4,80,,,percent of total billed charges,80% of total billed charges,27.72,24,,,percent of total billed charges,24% of total billed charges ,27.72,24,,,percent of total billed charges,24% of total billed charges ,22.35,92.4,
NEOSPORIN (TRIPLE) OINT,7003788,CDM,250,RC,,,Outpatient,,,26,13,,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,20.8,
MARCAINE (BUPIVACAINE) 0.5% 50ML INJ,7003789,CDM,250,RC,,,Outpatient,,,81.5,40.75,,21.89,26.86,,,percent of total billed charges,26.86% of total billed charges,61.13,75,,,percent of total billed charges,75% of total billed charges ,61.13,75,,,percent of total billed charges,75% of total billed charges ,19.56,24,,,percent of total billed charges,24% of total billed charges ,61.13,75,,,percent of total billed charges,75% of total billed charges ,61.13,75,,,percent of total billed charges,75% of total billed charges ,65.2,80,,,percent of total billed charges,80% of total billed charges ,19.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.13,75,,,percent of total billed charges,75% of total billed charges ,19.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.89,26.86,,,percent of total billed charges,26.86% of total billed charges,19.56,24,,,percent of total billed charges,24% of total billed charges ,25.43,31.2,,,percent of total billed charges,31.2% of total billed charges,65.2,80,,,percent of total billed charges,80% of total billed charges,19.56,24,,,percent of total billed charges,24% of total billed charges ,19.56,24,,,percent of total billed charges,24% of total billed charges ,19.56,65.2,
MARCAINE (BUPIVACAINE) 0.25% 10ML INJ,7003790,CDM,250,RC,,,Outpatient,,,70,35,,18.8,26.86,,,percent of total billed charges,26.86% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,16.8,24,,,percent of total billed charges,24% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,56,80,,,percent of total billed charges,80% of total billed charges ,16.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,17.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.8,26.86,,,percent of total billed charges,26.86% of total billed charges,16.8,24,,,percent of total billed charges,24% of total billed charges ,21.84,31.2,,,percent of total billed charges,31.2% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,16.8,24,,,percent of total billed charges,24% of total billed charges ,16.8,24,,,percent of total billed charges,24% of total billed charges ,16.8,56,
ZOVIRAX (ACYCLOVIR) 5% OINTMENT 15G,7003791,CDM,250,RC,,,Outpatient,,,1622.5,811.25,,435.8,26.86,,,percent of total billed charges,26.86% of total billed charges,1216.88,75,,,percent of total billed charges,75% of total billed charges ,1216.88,75,,,percent of total billed charges,75% of total billed charges ,389.4,24,,,percent of total billed charges,24% of total billed charges ,1216.88,75,,,percent of total billed charges,75% of total billed charges ,1216.88,75,,,percent of total billed charges,75% of total billed charges ,1298,80,,,percent of total billed charges,80% of total billed charges ,393.29,24.24,,,percent of total billed charges,24.24% of total billed charges ,817.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,1216.88,75,,,percent of total billed charges,75% of total billed charges ,397.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,435.8,26.86,,,percent of total billed charges,26.86% of total billed charges,389.4,24,,,percent of total billed charges,24% of total billed charges ,506.22,31.2,,,percent of total billed charges,31.2% of total billed charges,1298,80,,,percent of total billed charges,80% of total billed charges,389.4,24,,,percent of total billed charges,24% of total billed charges ,389.4,24,,,percent of total billed charges,24% of total billed charges ,389.4,1298,
RABIES (IMMUNE GLOB)  150U/ML 10ML,7003801,CDM,636,RC,90377,HCPCS,Outpatient,,,16282,8141,,256.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3907.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13025.6,80,,,percent of total billed charges,80% of total billed charges ,3946.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,8206.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,12211.5,75,,,percent of total billed charges,75% of total billed charges ,3985.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,256.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3907.68,24,,,percent of total billed charges,24% of total billed charges ,5079.98,31.2,,,percent of total billed charges,31.2% of total billed charges,13025.6,80,,,percent of total billed charges,80% of total billed charges,3907.68,24,,,percent of total billed charges,24% of total billed charges ,3907.68,24,,,percent of total billed charges,24% of total billed charges ,256.31,13025.6,
ZZZGAMMAGARD 10% 30GM (300ML),7003852,CDM,636,RC,J1569,HCPCS,Outpatient,,,20484.5,10242.25,,44.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4916.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16387.6,80,,,percent of total billed charges,80% of total billed charges ,4965.44,24.24,,,percent of total billed charges,24.24% of total billed charges ,10324.19,50.4,,,percent of total billed charges,50.4% of total billed charges ,15363.38,75,,,percent of total billed charges,75% of total billed charges ,5014.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,44.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4916.28,24,,,percent of total billed charges,24% of total billed charges ,6391.16,31.2,,,percent of total billed charges,31.2% of total billed charges,16387.6,80,,,percent of total billed charges,80% of total billed charges,4916.28,24,,,percent of total billed charges,24% of total billed charges ,4916.28,24,,,percent of total billed charges,24% of total billed charges ,44.15,16387.6,
"THROMBIN, TOPICAL (BOVINE) 5000U",7003867,CDM,250,RC,,,Outpatient,,,425.5,212.75,,114.29,26.86,,,percent of total billed charges,26.86% of total billed charges,319.13,75,,,percent of total billed charges,75% of total billed charges ,319.13,75,,,percent of total billed charges,75% of total billed charges ,102.12,24,,,percent of total billed charges,24% of total billed charges ,319.13,75,,,percent of total billed charges,75% of total billed charges ,319.13,75,,,percent of total billed charges,75% of total billed charges ,340.4,80,,,percent of total billed charges,80% of total billed charges ,103.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,214.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,319.13,75,,,percent of total billed charges,75% of total billed charges ,104.16,24.48,,,percent of total billed charges,24.48% of total billed charges ,114.29,26.86,,,percent of total billed charges,26.86% of total billed charges,102.12,24,,,percent of total billed charges,24% of total billed charges ,132.76,31.2,,,percent of total billed charges,31.2% of total billed charges,340.4,80,,,percent of total billed charges,80% of total billed charges,102.12,24,,,percent of total billed charges,24% of total billed charges ,102.12,24,,,percent of total billed charges,24% of total billed charges ,102.12,340.4,
MEFOXITIN (CEFOXITIN) 1GM INJ,7003868,CDM,636,RC,J0694,HCPCS,Outpatient,,,45.5,22.75,,5.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,36.4,80,,,percent of total billed charges,80% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,5.08,36.4,
ZZZIVERMECTIN 3MG TAB,7003911,CDM,250,RC,,,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
COLACE (DOCUSATE SOD) 100MG/10ML CUP,7003967,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
VIT A & D OINTMENT,7003968,CDM,250,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
SUPREP BOWEL PREP KIT,7003976,CDM,250,RC,,,Outpatient,,,541,270.5,,145.31,26.86,,,percent of total billed charges,26.86% of total billed charges,405.75,75,,,percent of total billed charges,75% of total billed charges ,405.75,75,,,percent of total billed charges,75% of total billed charges ,129.84,24,,,percent of total billed charges,24% of total billed charges ,405.75,75,,,percent of total billed charges,75% of total billed charges ,405.75,75,,,percent of total billed charges,75% of total billed charges ,432.8,80,,,percent of total billed charges,80% of total billed charges ,131.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,272.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,405.75,75,,,percent of total billed charges,75% of total billed charges ,132.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,145.31,26.86,,,percent of total billed charges,26.86% of total billed charges,129.84,24,,,percent of total billed charges,24% of total billed charges ,168.79,31.2,,,percent of total billed charges,31.2% of total billed charges,432.8,80,,,percent of total billed charges,80% of total billed charges,129.84,24,,,percent of total billed charges,24% of total billed charges ,129.84,24,,,percent of total billed charges,24% of total billed charges ,129.84,432.8,
ZZZDIPRIVAN (PROPOFOL) 500MG/50ML,7003995,CDM,636,RC,J2704,HCPCS,Outpatient,,,98,49,,26.32,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,78.4,80,,,percent of total billed charges,80% of total billed charges ,23.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,49.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,73.5,75,,,percent of total billed charges,75% of total billed charges ,23.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.32,26.86,,,percent of total billed charges,26.86% of total billed charges,23.52,24,,,percent of total billed charges,24% of total billed charges ,30.58,31.2,,,percent of total billed charges,31.2% of total billed charges,78.4,80,,,percent of total billed charges,80% of total billed charges,23.52,24,,,percent of total billed charges,24% of total billed charges ,23.52,24,,,percent of total billed charges,24% of total billed charges ,23.52,78.4,
"LIDOCAINE-EPI 2% 1:100,000 INJ 50ML",7004021,CDM,250,RC,,,Outpatient,,,53.5,26.75,,14.37,26.86,,,percent of total billed charges,26.86% of total billed charges,40.13,75,,,percent of total billed charges,75% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,42.8,80,,,percent of total billed charges,80% of total billed charges ,12.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,13.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.37,26.86,,,percent of total billed charges,26.86% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,16.69,31.2,,,percent of total billed charges,31.2% of total billed charges,42.8,80,,,percent of total billed charges,80% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,42.8,
NAFCILLIN  2GM VIAL,7004087,CDM,636,RC,S0032,HCPCS,Outpatient,,,147.5,73.75,,12.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,118,80,,,percent of total billed charges,80% of total billed charges ,35.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,74.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,110.63,75,,,percent of total billed charges,75% of total billed charges ,36.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,35.4,24,,,percent of total billed charges,24% of total billed charges ,46.02,31.2,,,percent of total billed charges,31.2% of total billed charges,118,80,,,percent of total billed charges,80% of total billed charges,35.4,24,,,percent of total billed charges,24% of total billed charges ,35.4,24,,,percent of total billed charges,24% of total billed charges ,12.5,118,
"PENICILLIN G  20,000,000 UNIT",7004140,CDM,636,RC,J2540,HCPCS,Outpatient,,,304,152,,0.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,72.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,243.2,80,,,percent of total billed charges,80% of total billed charges ,73.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,153.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,228,75,,,percent of total billed charges,75% of total billed charges ,74.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,72.96,24,,,percent of total billed charges,24% of total billed charges ,94.85,31.2,,,percent of total billed charges,31.2% of total billed charges,243.2,80,,,percent of total billed charges,80% of total billed charges,72.96,24,,,percent of total billed charges,24% of total billed charges ,72.96,24,,,percent of total billed charges,24% of total billed charges ,0.77,243.2,
NAFCILLIN 10GM,7004148,CDM,636,RC,S0032,HCPCS,Outpatient,,,514,257,,12.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,123.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,411.2,80,,,percent of total billed charges,80% of total billed charges ,124.59,24.24,,,percent of total billed charges,24.24% of total billed charges ,259.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,385.5,75,,,percent of total billed charges,75% of total billed charges ,125.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,123.36,24,,,percent of total billed charges,24% of total billed charges ,160.37,31.2,,,percent of total billed charges,31.2% of total billed charges,411.2,80,,,percent of total billed charges,80% of total billed charges,123.36,24,,,percent of total billed charges,24% of total billed charges ,123.36,24,,,percent of total billed charges,24% of total billed charges ,12.5,411.2,
MYCAMINE (MICAFUNGIN) 50MG,7004170,CDM,636,RC,J2248,HCPCS,Outpatient,,,4502,2251,,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1080.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3601.6,80,,,percent of total billed charges,80% of total billed charges ,1091.28,24.24,,,percent of total billed charges,24.24% of total billed charges ,2269.01,50.4,,,percent of total billed charges,50.4% of total billed charges ,3376.5,75,,,percent of total billed charges,75% of total billed charges ,1102.09,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,1080.48,24,,,percent of total billed charges,24% of total billed charges ,1404.62,31.2,,,percent of total billed charges,31.2% of total billed charges,3601.6,80,,,percent of total billed charges,80% of total billed charges,1080.48,24,,,percent of total billed charges,24% of total billed charges ,1080.48,24,,,percent of total billed charges,24% of total billed charges ,0.76,3601.6,
ZZZDESMOPRESSIN 0.2MG TABLET,7004208,CDM,250,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
JEVITY  1.2 1000ML BOTTLE,7004223,CDM,250,RC,,,Outpatient,,,53.5,26.75,,14.37,26.86,,,percent of total billed charges,26.86% of total billed charges,40.13,75,,,percent of total billed charges,75% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,42.8,80,,,percent of total billed charges,80% of total billed charges ,12.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,13.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.37,26.86,,,percent of total billed charges,26.86% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,16.69,31.2,,,percent of total billed charges,31.2% of total billed charges,42.8,80,,,percent of total billed charges,80% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,42.8,
"LIDOCAINE-EPI 1% 1:100,000 INJ 10ML",7004294,CDM,250,RC,,,Outpatient,,,28,14,,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,22.4,80,,,percent of total billed charges,80% of total billed charges ,6.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,8.74,31.2,,,percent of total billed charges,31.2% of total billed charges,22.4,80,,,percent of total billed charges,80% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,22.4,
STERILE WATER INJ 2000ML,7004311,CDM,258,RC,,,Outpatient,,,49.5,24.75,,13.3,26.86,,,percent of total billed charges,26.86% of total billed charges,37.13,75,,,percent of total billed charges,75% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,11.88,24,,,percent of total billed charges,24% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,39.6,80,,,percent of total billed charges,80% of total billed charges ,12,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,12.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.3,26.86,,,percent of total billed charges,26.86% of total billed charges,11.88,24,,,percent of total billed charges,24% of total billed charges ,15.44,31.2,,,percent of total billed charges,31.2% of total billed charges,39.6,80,,,percent of total billed charges,80% of total billed charges,11.88,24,,,percent of total billed charges,24% of total billed charges ,11.88,24,,,percent of total billed charges,24% of total billed charges ,11.88,39.6,
KENALOG (TRIAMCINOLONE) 40MG/ML(10ML),7004420,CDM,636,RC,J3301,HCPCS,Outpatient,,,46.5,23.25,,0.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,0.95,37.2,
SANDOSTATIN (OCTREOTIDE) 0.05MG/ML,7004443,CDM,636,RC,J2354,HCPCS,Outpatient,,,91.5,45.75,,1.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,73.2,80,,,percent of total billed charges,80% of total billed charges ,22.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,46.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,68.63,75,,,percent of total billed charges,75% of total billed charges ,22.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.96,24,,,percent of total billed charges,24% of total billed charges ,28.55,31.2,,,percent of total billed charges,31.2% of total billed charges,73.2,80,,,percent of total billed charges,80% of total billed charges,21.96,24,,,percent of total billed charges,24% of total billed charges ,21.96,24,,,percent of total billed charges,24% of total billed charges ,1.19,73.2,
STERILE WATER INJ 3000ML,7004488,CDM,258,RC,,,Outpatient,,,75,37.5,,20.15,26.86,,,percent of total billed charges,26.86% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,18,24,,,percent of total billed charges,24% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,60,80,,,percent of total billed charges,80% of total billed charges ,18.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,18.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.15,26.86,,,percent of total billed charges,26.86% of total billed charges,18,24,,,percent of total billed charges,24% of total billed charges ,23.4,31.2,,,percent of total billed charges,31.2% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,18,24,,,percent of total billed charges,24% of total billed charges ,18,24,,,percent of total billed charges,24% of total billed charges ,18,60,
VERSED (MIDAZOLAM) 25MG/5ML INJECT,7004502,CDM,636,RC,J2250,HCPCS,Outpatient,,,65,32.5,,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52,80,,,percent of total billed charges,80% of total billed charges ,15.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.6,24,,,percent of total billed charges,24% of total billed charges ,20.28,31.2,,,percent of total billed charges,31.2% of total billed charges,52,80,,,percent of total billed charges,80% of total billed charges,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,0.14,52,
CLINIMIX(4.25/10%) 1000ML(CENTRAL LINE),7004503,CDM,272,RC,B4189,HCPCS,Outpatient,,,206,103,,55.33,26.86,,,percent of total billed charges,26.86% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,164.8,80,,,percent of total billed charges,80% of total billed charges ,49.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,103.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,50.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,55.33,26.86,,,percent of total billed charges,26.86% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,64.27,31.2,,,percent of total billed charges,31.2% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,164.8,
CLINIMIX E-DEX(4.25-5%)1000ML,7004504,CDM,272,RC,B4189,HCPCS,Outpatient,,,267,133.5,,71.72,26.86,,,percent of total billed charges,26.86% of total billed charges,200.25,75,,,percent of total billed charges,75% of total billed charges ,200.25,75,,,percent of total billed charges,75% of total billed charges ,64.08,24,,,percent of total billed charges,24% of total billed charges ,200.25,75,,,percent of total billed charges,75% of total billed charges ,200.25,75,,,percent of total billed charges,75% of total billed charges ,213.6,80,,,percent of total billed charges,80% of total billed charges ,64.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,134.57,50.4,,,percent of total billed charges,50.4% of total billed charges ,200.25,75,,,percent of total billed charges,75% of total billed charges ,65.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,71.72,26.86,,,percent of total billed charges,26.86% of total billed charges,64.08,24,,,percent of total billed charges,24% of total billed charges ,83.3,31.2,,,percent of total billed charges,31.2% of total billed charges,213.6,80,,,percent of total billed charges,80% of total billed charges,64.08,24,,,percent of total billed charges,24% of total billed charges ,64.08,24,,,percent of total billed charges,24% of total billed charges ,64.08,213.6,
DIPRIVAN (PROPOFOL) 1000/100ML,7004505,CDM,636,RC,J2704,HCPCS,Outpatient,,,183.5,91.75,,49.29,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,44.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,146.8,80,,,percent of total billed charges,80% of total billed charges ,44.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,92.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,137.63,75,,,percent of total billed charges,75% of total billed charges ,44.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,49.29,26.86,,,percent of total billed charges,26.86% of total billed charges,44.04,24,,,percent of total billed charges,24% of total billed charges ,57.25,31.2,,,percent of total billed charges,31.2% of total billed charges,146.8,80,,,percent of total billed charges,80% of total billed charges,44.04,24,,,percent of total billed charges,24% of total billed charges ,44.04,24,,,percent of total billed charges,24% of total billed charges ,44.04,146.8,
TEARS (ARTIFICIAL TEARS) 15ML,7004511,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
VITAMIN D3 5000IU/1ML DROPS (52ML),7004516,CDM,250,RC,,,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
LIPIDS 20% (LIPOSYN) 100ML IV,7004518,CDM,272,RC,B4185,HCPCS,Outpatient,,,177,88.5,,47.54,26.86,,,percent of total billed charges,26.86% of total billed charges,132.75,75,,,percent of total billed charges,75% of total billed charges ,132.75,75,,,percent of total billed charges,75% of total billed charges ,42.48,24,,,percent of total billed charges,24% of total billed charges ,132.75,75,,,percent of total billed charges,75% of total billed charges ,132.75,75,,,percent of total billed charges,75% of total billed charges ,141.6,80,,,percent of total billed charges,80% of total billed charges ,42.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,132.75,75,,,percent of total billed charges,75% of total billed charges ,43.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.54,26.86,,,percent of total billed charges,26.86% of total billed charges,42.48,24,,,percent of total billed charges,24% of total billed charges ,55.22,31.2,,,percent of total billed charges,31.2% of total billed charges,141.6,80,,,percent of total billed charges,80% of total billed charges,42.48,24,,,percent of total billed charges,24% of total billed charges ,42.48,24,,,percent of total billed charges,24% of total billed charges ,42.48,141.6,
ZZZFLUZONE HI-DOSE  0.7ML 21-22,7004564,CDM,636,RC,90662,HCPCS,Outpatient,,,345,172.5,,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,82.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,276,80,,,percent of total billed charges,80% of total billed charges ,83.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,173.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,258.75,75,,,percent of total billed charges,75% of total billed charges ,84.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,82.8,24,,,percent of total billed charges,24% of total billed charges ,107.64,31.2,,,percent of total billed charges,31.2% of total billed charges,276,80,,,percent of total billed charges,80% of total billed charges,82.8,24,,,percent of total billed charges,24% of total billed charges ,82.8,24,,,percent of total billed charges,24% of total billed charges ,73.4,276,
ZZZFLUZONE QUAD 0.5ML 2021-2022,7004565,CDM,636,RC,90686,HCPCS,Outpatient,,,119.5,59.75,,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.6,80,,,percent of total billed charges,80% of total billed charges ,28.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,89.63,75,,,percent of total billed charges,75% of total billed charges ,29.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.68,24,,,percent of total billed charges,24% of total billed charges ,37.28,31.2,,,percent of total billed charges,31.2% of total billed charges,95.6,80,,,percent of total billed charges,80% of total billed charges,28.68,24,,,percent of total billed charges,24% of total billed charges ,28.68,24,,,percent of total billed charges,24% of total billed charges ,22.35,95.6,
ZZZTOBRAMYCIN INHALATION SOLU 300MG/5ML,7004580,CDM,636,RC,J7682,HCPCS,Outpatient,,,204,102,,54.79,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,163.2,80,,,percent of total billed charges,80% of total billed charges ,49.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,102.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,153,75,,,percent of total billed charges,75% of total billed charges ,49.94,24.48,,,percent of total billed charges,24.48% of total billed charges ,54.79,26.86,,,percent of total billed charges,26.86% of total billed charges,48.96,24,,,percent of total billed charges,24% of total billed charges ,63.65,31.2,,,percent of total billed charges,31.2% of total billed charges,163.2,80,,,percent of total billed charges,80% of total billed charges,48.96,24,,,percent of total billed charges,24% of total billed charges ,48.96,24,,,percent of total billed charges,24% of total billed charges ,48.96,163.2,
SENNA SYRUP 8.8MG/5ML,7004712,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
REGITINE (PHENTOLAMINE) 5MG IM/IV,7004755,CDM,636,RC,J2760,HCPCS,Outpatient,,,2040.5,1020.25,,548.08,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,489.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1632.4,80,,,percent of total billed charges,80% of total billed charges ,494.62,24.24,,,percent of total billed charges,24.24% of total billed charges ,1028.41,50.4,,,percent of total billed charges,50.4% of total billed charges ,1530.38,75,,,percent of total billed charges,75% of total billed charges ,499.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,548.08,26.86,,,percent of total billed charges,26.86% of total billed charges,489.72,24,,,percent of total billed charges,24% of total billed charges ,636.64,31.2,,,percent of total billed charges,31.2% of total billed charges,1632.4,80,,,percent of total billed charges,80% of total billed charges,489.72,24,,,percent of total billed charges,24% of total billed charges ,489.72,24,,,percent of total billed charges,24% of total billed charges ,489.72,1632.4,
TOPROL XL (METOPROLOL SUCCINATE) 25MG,7004787,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
LIDOCAINE 1% 300MG/30ML,7004803,CDM,636,RC,J2001,HCPCS,Outpatient,,,71,35.5,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.8,80,,,percent of total billed charges,80% of total billed charges ,17.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.04,24,,,percent of total billed charges,24% of total billed charges ,22.15,31.2,,,percent of total billed charges,31.2% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,17.04,24,,,percent of total billed charges,24% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,0.03,56.8,
TOPROL XL (METOPROLOL SUCCINATE) 50MG,7004804,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
AMPICILLLIN 500MG CAP,7004812,CDM,250,RC,,,Outpatient,,,13.5,6.75,,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.8,80,,,percent of total billed charges,80% of total billed charges ,3.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,4.21,31.2,,,percent of total billed charges,31.2% of total billed charges,10.8,80,,,percent of total billed charges,80% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,10.8,
FENTANYL 500MCG/10ML INJ,7004835,CDM,636,RC,J3010,HCPCS,Outpatient,,,29,14.5,,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.2,80,,,percent of total billed charges,80% of total billed charges ,7.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,7.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.96,24,,,percent of total billed charges,24% of total billed charges ,9.05,31.2,,,percent of total billed charges,31.2% of total billed charges,23.2,80,,,percent of total billed charges,80% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,0.97,23.2,
TOPICORT (DESOXIMETA) 0.25% CRM 15GM,7004838,CDM,250,RC,,,Outpatient,,,290.5,145.25,,78.03,26.86,,,percent of total billed charges,26.86% of total billed charges,217.88,75,,,percent of total billed charges,75% of total billed charges ,217.88,75,,,percent of total billed charges,75% of total billed charges ,69.72,24,,,percent of total billed charges,24% of total billed charges ,217.88,75,,,percent of total billed charges,75% of total billed charges ,217.88,75,,,percent of total billed charges,75% of total billed charges ,232.4,80,,,percent of total billed charges,80% of total billed charges ,70.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,146.41,50.4,,,percent of total billed charges,50.4% of total billed charges ,217.88,75,,,percent of total billed charges,75% of total billed charges ,71.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,78.03,26.86,,,percent of total billed charges,26.86% of total billed charges,69.72,24,,,percent of total billed charges,24% of total billed charges ,90.64,31.2,,,percent of total billed charges,31.2% of total billed charges,232.4,80,,,percent of total billed charges,80% of total billed charges,69.72,24,,,percent of total billed charges,24% of total billed charges ,69.72,24,,,percent of total billed charges,24% of total billed charges ,69.72,232.4,
TOPICORT (DESOXIMETA) 0.25% CRM 15GM,7004839,CDM,250,RC,,,Outpatient,,,290.5,145.25,,78.03,26.86,,,percent of total billed charges,26.86% of total billed charges,217.88,75,,,percent of total billed charges,75% of total billed charges ,217.88,75,,,percent of total billed charges,75% of total billed charges ,69.72,24,,,percent of total billed charges,24% of total billed charges ,217.88,75,,,percent of total billed charges,75% of total billed charges ,217.88,75,,,percent of total billed charges,75% of total billed charges ,232.4,80,,,percent of total billed charges,80% of total billed charges ,70.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,146.41,50.4,,,percent of total billed charges,50.4% of total billed charges ,217.88,75,,,percent of total billed charges,75% of total billed charges ,71.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,78.03,26.86,,,percent of total billed charges,26.86% of total billed charges,69.72,24,,,percent of total billed charges,24% of total billed charges ,90.64,31.2,,,percent of total billed charges,31.2% of total billed charges,232.4,80,,,percent of total billed charges,80% of total billed charges,69.72,24,,,percent of total billed charges,24% of total billed charges ,69.72,24,,,percent of total billed charges,24% of total billed charges ,69.72,232.4,
ZZZRABAVERT (CHICK-EMB CELL) 2.5U/ML,7004843,CDM,636,RC,90675,HCPCS,Outpatient,,,1846,923,,324.74,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,443.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1476.8,80,,,percent of total billed charges,80% of total billed charges ,447.47,24.24,,,percent of total billed charges,24.24% of total billed charges ,930.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,1384.5,75,,,percent of total billed charges,75% of total billed charges ,451.9,24.48,,,percent of total billed charges,24.48% of total billed charges ,324.74,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,443.04,24,,,percent of total billed charges,24% of total billed charges ,575.95,31.2,,,percent of total billed charges,31.2% of total billed charges,1476.8,80,,,percent of total billed charges,80% of total billed charges,443.04,24,,,percent of total billed charges,24% of total billed charges ,443.04,24,,,percent of total billed charges,24% of total billed charges ,324.74,1476.8,
MICAFUNGIN 100MG INJ,7004943,CDM,636,RC,J2248,HCPCS,Outpatient,,,928,464,,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,222.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,742.4,80,,,percent of total billed charges,80% of total billed charges ,224.95,24.24,,,percent of total billed charges,24.24% of total billed charges ,467.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,696,75,,,percent of total billed charges,75% of total billed charges ,227.17,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,222.72,24,,,percent of total billed charges,24% of total billed charges ,289.54,31.2,,,percent of total billed charges,31.2% of total billed charges,742.4,80,,,percent of total billed charges,80% of total billed charges,222.72,24,,,percent of total billed charges,24% of total billed charges ,222.72,24,,,percent of total billed charges,24% of total billed charges ,0.76,742.4,
MORPHINE SUL 2MG IM / IV,7004983,CDM,636,RC,J2270,HCPCS,Outpatient,,,28,14,,4.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.4,80,,,percent of total billed charges,80% of total billed charges ,6.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.72,24,,,percent of total billed charges,24% of total billed charges ,8.74,31.2,,,percent of total billed charges,31.2% of total billed charges,22.4,80,,,percent of total billed charges,80% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,4.67,22.4,
ZZZZOSYN (PIPERACILLIN-TAZ) 2.25GM INJ,7005007,CDM,636,RC,J2543,HCPCS,Outpatient,,,116.5,58.25,,1.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,93.2,80,,,percent of total billed charges,80% of total billed charges ,28.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,58.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,28.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.96,24,,,percent of total billed charges,24% of total billed charges ,36.35,31.2,,,percent of total billed charges,31.2% of total billed charges,93.2,80,,,percent of total billed charges,80% of total billed charges,27.96,24,,,percent of total billed charges,24% of total billed charges ,27.96,24,,,percent of total billed charges,24% of total billed charges ,1.18,93.2,
ZZZVABOMERE 2GM (MEROPENEM/VABORBACTAM),7005009,CDM,636,RC,J2186,HCPCS,Outpatient,,,1018.5,509.25,,273.57,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,244.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,814.8,80,,,percent of total billed charges,80% of total billed charges ,246.88,24.24,,,percent of total billed charges,24.24% of total billed charges ,513.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,763.88,75,,,percent of total billed charges,75% of total billed charges ,249.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,273.57,26.86,,,percent of total billed charges,26.86% of total billed charges,244.44,24,,,percent of total billed charges,24% of total billed charges ,317.77,31.2,,,percent of total billed charges,31.2% of total billed charges,814.8,80,,,percent of total billed charges,80% of total billed charges,244.44,24,,,percent of total billed charges,24% of total billed charges ,244.44,24,,,percent of total billed charges,24% of total billed charges ,244.44,814.8,
VANCOMYCIN (FIRVANQ) 250MG/5ML SUSP,7005013,CDM,250,RC,,,Outpatient,,,715,357.5,,192.05,26.86,,,percent of total billed charges,26.86% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges ,536.25,75,,,percent of total billed charges,75% of total billed charges ,171.6,24,,,percent of total billed charges,24% of total billed charges ,536.25,75,,,percent of total billed charges,75% of total billed charges ,536.25,75,,,percent of total billed charges,75% of total billed charges ,572,80,,,percent of total billed charges,80% of total billed charges ,173.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,360.36,50.4,,,percent of total billed charges,50.4% of total billed charges ,536.25,75,,,percent of total billed charges,75% of total billed charges ,175.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,192.05,26.86,,,percent of total billed charges,26.86% of total billed charges,171.6,24,,,percent of total billed charges,24% of total billed charges ,223.08,31.2,,,percent of total billed charges,31.2% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,171.6,24,,,percent of total billed charges,24% of total billed charges ,171.6,24,,,percent of total billed charges,24% of total billed charges ,171.6,572,
ZZZORBACTIV 400MG VIAL,7005030,CDM,636,RC,J2407,HCPCS,Outpatient,,,5260,2630,,27.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1262.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4208,80,,,percent of total billed charges,80% of total billed charges ,1275.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,2651.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,3945,75,,,percent of total billed charges,75% of total billed charges ,1287.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,1262.4,24,,,percent of total billed charges,24% of total billed charges ,1641.12,31.2,,,percent of total billed charges,31.2% of total billed charges,4208,80,,,percent of total billed charges,80% of total billed charges,1262.4,24,,,percent of total billed charges,24% of total billed charges ,1262.4,24,,,percent of total billed charges,24% of total billed charges ,27.6,4208,
THORAZINE (CHLORPROMAZINE) 200MG TAB,7005048,CDM,259,RC,,,Outpatient,,,170,85,,45.66,26.86,,,percent of total billed charges,26.86% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,40.8,24,,,percent of total billed charges,24% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,136,80,,,percent of total billed charges,80% of total billed charges ,41.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,85.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,41.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,45.66,26.86,,,percent of total billed charges,26.86% of total billed charges,40.8,24,,,percent of total billed charges,24% of total billed charges ,53.04,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,40.8,24,,,percent of total billed charges,24% of total billed charges ,40.8,24,,,percent of total billed charges,24% of total billed charges ,40.8,136,
ANCEF (CEFAZOLIN) 2GM INJ,7005056,CDM,636,RC,J0690,HCPCS,Outpatient,,,46.5,23.25,,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,0.76,37.2,
PHENOBARBITAL 30MG/7.5MLELIXIR,7005058,CDM,250,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
ROBITUSSIN AC (GUA/COD) 200-20MG/10ML,7005130,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ISOVUE-370 100ML (LOPAMIDOL INJ 76%),7005209,CDM,250,RC,,,Outpatient,,,488,244,,131.08,26.86,,,percent of total billed charges,26.86% of total billed charges,366,75,,,percent of total billed charges,75% of total billed charges ,366,75,,,percent of total billed charges,75% of total billed charges ,117.12,24,,,percent of total billed charges,24% of total billed charges ,366,75,,,percent of total billed charges,75% of total billed charges ,366,75,,,percent of total billed charges,75% of total billed charges ,390.4,80,,,percent of total billed charges,80% of total billed charges ,118.29,24.24,,,percent of total billed charges,24.24% of total billed charges ,245.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,366,75,,,percent of total billed charges,75% of total billed charges ,119.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,131.08,26.86,,,percent of total billed charges,26.86% of total billed charges,117.12,24,,,percent of total billed charges,24% of total billed charges ,152.26,31.2,,,percent of total billed charges,31.2% of total billed charges,390.4,80,,,percent of total billed charges,80% of total billed charges,117.12,24,,,percent of total billed charges,24% of total billed charges ,117.12,24,,,percent of total billed charges,24% of total billed charges ,117.12,390.4,
PEDIAPRED (PREDNISOLONE) 15MG /5 ML UD,7005257,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
LIDOCAINE 1% 50MG/5ML SINGLE DOSE VIAL,7005262,CDM,636,RC,J2001,HCPCS,Outpatient,,,30,15,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24,80,,,percent of total billed charges,80% of total billed charges ,7.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.2,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,,,percent of total billed charges,31.2% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,0.03,24,
MULTIHANCE (GADOBENATE 529MG/ML) 20ML,7005271,CDM,250,RC,,,Outpatient,,,541,270.5,,145.31,26.86,,,percent of total billed charges,26.86% of total billed charges,405.75,75,,,percent of total billed charges,75% of total billed charges ,405.75,75,,,percent of total billed charges,75% of total billed charges ,129.84,24,,,percent of total billed charges,24% of total billed charges ,405.75,75,,,percent of total billed charges,75% of total billed charges ,405.75,75,,,percent of total billed charges,75% of total billed charges ,432.8,80,,,percent of total billed charges,80% of total billed charges ,131.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,272.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,405.75,75,,,percent of total billed charges,75% of total billed charges ,132.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,145.31,26.86,,,percent of total billed charges,26.86% of total billed charges,129.84,24,,,percent of total billed charges,24% of total billed charges ,168.79,31.2,,,percent of total billed charges,31.2% of total billed charges,432.8,80,,,percent of total billed charges,80% of total billed charges,129.84,24,,,percent of total billed charges,24% of total billed charges ,129.84,24,,,percent of total billed charges,24% of total billed charges ,129.84,432.8,
ISOVUE-370  50ML (LOPAMIDOL INJ 76%),7005303,CDM,250,RC,Q9967,HCPCS,Outpatient,,,250.5,125.25,,67.28,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,200.4,80,,,percent of total billed charges,80% of total billed charges ,60.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,126.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,187.88,75,,,percent of total billed charges,75% of total billed charges ,61.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,67.28,26.86,,,percent of total billed charges,26.86% of total billed charges,60.12,24,,,percent of total billed charges,24% of total billed charges ,78.16,31.2,,,percent of total billed charges,31.2% of total billed charges,200.4,80,,,percent of total billed charges,80% of total billed charges,60.12,24,,,percent of total billed charges,24% of total billed charges ,60.12,24,,,percent of total billed charges,24% of total billed charges ,60.12,200.4,
BENADRYL (DIPHENHY) 12.5MG/5ML(120ML BOT,7005357,CDM,250,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
ZZZFLUZONE HI-DOSE(INFLUENZA)0.7ML 22-23,7005360,CDM,636,RC,90662,HCPCS,Outpatient,,,363.5,181.75,,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,87.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,290.8,80,,,percent of total billed charges,80% of total billed charges ,88.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,183.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,272.63,75,,,percent of total billed charges,75% of total billed charges ,88.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,87.24,24,,,percent of total billed charges,24% of total billed charges ,113.41,31.2,,,percent of total billed charges,31.2% of total billed charges,290.8,80,,,percent of total billed charges,80% of total billed charges,87.24,24,,,percent of total billed charges,24% of total billed charges ,87.24,24,,,percent of total billed charges,24% of total billed charges ,73.4,290.8,
ZZZFLUZONE QUAD(INFLUENZA)0.5ML2022-2023,7005361,CDM,636,RC,90686,HCPCS,Outpatient,,,121.5,60.75,,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,97.2,80,,,percent of total billed charges,80% of total billed charges ,29.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.16,24,,,percent of total billed charges,24% of total billed charges ,37.91,31.2,,,percent of total billed charges,31.2% of total billed charges,97.2,80,,,percent of total billed charges,80% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,22.35,97.2,
PREVNAR 20,7005384,CDM,636,RC,90670,HCPCS,Outpatient,,,1248.5,624.25,,257.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,299.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,998.8,80,,,percent of total billed charges,80% of total billed charges ,302.64,24.24,,,percent of total billed charges,24.24% of total billed charges ,629.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,936.38,75,,,percent of total billed charges,75% of total billed charges ,305.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,257.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,299.64,24,,,percent of total billed charges,24% of total billed charges ,389.53,31.2,,,percent of total billed charges,31.2% of total billed charges,998.8,80,,,percent of total billed charges,80% of total billed charges,299.64,24,,,percent of total billed charges,24% of total billed charges ,299.64,24,,,percent of total billed charges,24% of total billed charges ,257.99,998.8,
LAMICTAL (LAMOTRIGINE) 100MG TAB,7005457,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
VOLTAREN 1% GEL (DICLOFENAC),7005458,CDM,250,RC,,,Outpatient,,,103,51.5,,27.67,26.86,,,percent of total billed charges,26.86% of total billed charges,77.25,75,,,percent of total billed charges,75% of total billed charges ,77.25,75,,,percent of total billed charges,75% of total billed charges ,24.72,24,,,percent of total billed charges,24% of total billed charges ,77.25,75,,,percent of total billed charges,75% of total billed charges ,77.25,75,,,percent of total billed charges,75% of total billed charges ,82.4,80,,,percent of total billed charges,80% of total billed charges ,24.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,51.91,50.4,,,percent of total billed charges,50.4% of total billed charges ,77.25,75,,,percent of total billed charges,75% of total billed charges ,25.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.67,26.86,,,percent of total billed charges,26.86% of total billed charges,24.72,24,,,percent of total billed charges,24% of total billed charges ,32.14,31.2,,,percent of total billed charges,31.2% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,24.72,24,,,percent of total billed charges,24% of total billed charges ,24.72,24,,,percent of total billed charges,24% of total billed charges ,24.72,82.4,
XARACOLL (BUPIVACAINE)  3X100MG IMPLANT,7005487,CDM,636,RC,C9089,HCPCS,Outpatient,,,1225,612.5,,329.04,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,294,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,980,80,,,percent of total billed charges,80% of total billed charges ,296.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,617.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,918.75,75,,,percent of total billed charges,75% of total billed charges ,299.88,24.48,,,percent of total billed charges,24.48% of total billed charges ,329.04,26.86,,,percent of total billed charges,26.86% of total billed charges,294,24,,,percent of total billed charges,24% of total billed charges ,382.2,31.2,,,percent of total billed charges,31.2% of total billed charges,980,80,,,percent of total billed charges,80% of total billed charges,294,24,,,percent of total billed charges,24% of total billed charges ,294,24,,,percent of total billed charges,24% of total billed charges ,294,980,
CUBICIN (DAPTOMYCIN) 350MG INJ,7005489,CDM,636,RC,J0878,HCPCS,Outpatient,,,384,192,,0.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,92.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,307.2,80,,,percent of total billed charges,80% of total billed charges ,93.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,193.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,288,75,,,percent of total billed charges,75% of total billed charges ,94,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,92.16,24,,,percent of total billed charges,24% of total billed charges ,119.81,31.2,,,percent of total billed charges,31.2% of total billed charges,307.2,80,,,percent of total billed charges,80% of total billed charges,92.16,24,,,percent of total billed charges,24% of total billed charges ,92.16,24,,,percent of total billed charges,24% of total billed charges ,0.04,307.2,
XARELTO (RIVAROXABAN) 10MG,7005502,CDM,250,RC,,,Outpatient,,,112.5,56.25,,30.22,26.86,,,percent of total billed charges,26.86% of total billed charges,84.38,75,,,percent of total billed charges,75% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,27,24,,,percent of total billed charges,24% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,90,80,,,percent of total billed charges,80% of total billed charges ,27.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,56.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,27.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.22,26.86,,,percent of total billed charges,26.86% of total billed charges,27,24,,,percent of total billed charges,24% of total billed charges ,35.1,31.2,,,percent of total billed charges,31.2% of total billed charges,90,80,,,percent of total billed charges,80% of total billed charges,27,24,,,percent of total billed charges,24% of total billed charges ,27,24,,,percent of total billed charges,24% of total billed charges ,27,90,
ZOFRAN (ONDANSETRON) 2MG/2.5M ORAL SOLU,7005569,CDM,250,RC,Q0162,HCPCS,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
LIDOCAINE 2% 200MG/10ML VIAL,7005570,CDM,636,RC,J2001,HCPCS,Outpatient,,,34,17,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,0.03,27.2,
CROFAB (ANTIVENIN CROTALIDAE)1GM,7005605,CDM,636,RC,J0840,HCPCS,Outpatient,,,14858,7429,,3990.86,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3565.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11886.4,80,,,percent of total billed charges,80% of total billed charges ,3601.58,24.24,,,percent of total billed charges,24.24% of total billed charges ,7488.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,11143.5,75,,,percent of total billed charges,75% of total billed charges ,3637.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,3990.86,26.86,,,percent of total billed charges,26.86% of total billed charges,3565.92,24,,,percent of total billed charges,24% of total billed charges ,4635.7,31.2,,,percent of total billed charges,31.2% of total billed charges,11886.4,80,,,percent of total billed charges,80% of total billed charges,3565.92,24,,,percent of total billed charges,24% of total billed charges ,3565.92,24,,,percent of total billed charges,24% of total billed charges ,3565.92,11886.4,
SUGAMMADEX (BRIDION) 200MG/2ML INJ,7005619,CDM,250,RC,J3490,HCPCS,Outpatient,,,607.5,303.75,,163.17,26.86,,,percent of total billed charges,26.86% of total billed charges,455.63,75,,,percent of total billed charges,75% of total billed charges ,455.63,75,,,percent of total billed charges,75% of total billed charges ,145.8,24,,,percent of total billed charges,24% of total billed charges ,455.63,75,,,percent of total billed charges,75% of total billed charges ,455.63,75,,,percent of total billed charges,75% of total billed charges ,486,80,,,percent of total billed charges,80% of total billed charges ,147.26,24.24,,,percent of total billed charges,24.24% of total billed charges ,306.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,455.63,75,,,percent of total billed charges,75% of total billed charges ,148.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,163.17,26.86,,,percent of total billed charges,26.86% of total billed charges,145.8,24,,,percent of total billed charges,24% of total billed charges ,189.54,31.2,,,percent of total billed charges,31.2% of total billed charges,486,80,,,percent of total billed charges,80% of total billed charges,145.8,24,,,percent of total billed charges,24% of total billed charges ,145.8,24,,,percent of total billed charges,24% of total billed charges ,145.8,486,
STERILE WATER (REFRIGERATED)  INJ 1000ML,7005637,CDM,258,RC,,,Outpatient,,,64,32,,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,51.2,
NS (0.9% SOD CHL) REFRIGERATED 1000ML IV,7005638,CDM,636,RC,J7030,HCPCS,Outpatient,,,64,32,,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,2.69,51.2,
DALVANCE/D5W IVPB : 500MG/100ML,7005642,CDM,258,RC,J0875,HCPCS,Outpatient,,,,,,15.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.29,15.29,
DALVANCE/D5W IVPB : 1GM/250ML,7005643,CDM,258,RC,J0875,HCPCS,Outpatient,,,,,,15.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.29,15.29,
DALVANCE/D5W IVPB : 1.5GM/500ML,7005644,CDM,258,RC,J0875,HCPCS,Outpatient,,,,,,15.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.29,15.29,
CUBICIN/NS IVPB 1GM/100ML,7005663,CDM,636,RC,J0878,HCPCS,Outpatient,,,,,,0.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.04,0.04,
TRANEXAMIC ACID 1000MG/10ML,7005707,CDM,636,RC,,,Outpatient,,,40,20,,10.74,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32,80,,,percent of total billed charges,80% of total billed charges ,9.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,9.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.74,26.86,,,percent of total billed charges,26.86% of total billed charges,9.6,24,,,percent of total billed charges,24% of total billed charges ,12.48,31.2,,,percent of total billed charges,31.2% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,9.6,24,,,percent of total billed charges,24% of total billed charges ,9.6,24,,,percent of total billed charges,24% of total billed charges ,9.6,32,
RSI - KETAMINE 500MG/5ML INJ,7005735,CDM,250,RC,,,Outpatient,,,64,32,,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,51.2,
RSI - FENTANYL 250MCG/5ML INJ,7005736,CDM,636,RC,J3010,HCPCS,Outpatient,,,29,14.5,,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.2,80,,,percent of total billed charges,80% of total billed charges ,7.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,7.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.96,24,,,percent of total billed charges,24% of total billed charges ,9.05,31.2,,,percent of total billed charges,31.2% of total billed charges,23.2,80,,,percent of total billed charges,80% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,0.97,23.2,
RSI - FENTANYL 100MCG/2ML,7005737,CDM,636,RC,J3010,HCPCS,Outpatient,,,21.5,10.75,,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,0.97,17.2,
RSI - MIDAZOLAM (VERSED) 5MG/ML,7005738,CDM,636,RC,J2250,HCPCS,Outpatient,,,27,13.5,,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,0.14,21.6,
ZZZDUONEB  (0.5/3MG) 3ML UD NEB,7005744,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
KETALAR (KETAMINE) 200MG/20ML,7005747,CDM,250,RC,,,Outpatient,,,123.5,61.75,,33.17,26.86,,,percent of total billed charges,26.86% of total billed charges,92.63,75,,,percent of total billed charges,75% of total billed charges ,92.63,75,,,percent of total billed charges,75% of total billed charges ,29.64,24,,,percent of total billed charges,24% of total billed charges ,92.63,75,,,percent of total billed charges,75% of total billed charges ,92.63,75,,,percent of total billed charges,75% of total billed charges ,98.8,80,,,percent of total billed charges,80% of total billed charges ,29.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,62.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,92.63,75,,,percent of total billed charges,75% of total billed charges ,30.23,24.48,,,percent of total billed charges,24.48% of total billed charges ,33.17,26.86,,,percent of total billed charges,26.86% of total billed charges,29.64,24,,,percent of total billed charges,24% of total billed charges ,38.53,31.2,,,percent of total billed charges,31.2% of total billed charges,98.8,80,,,percent of total billed charges,80% of total billed charges,29.64,24,,,percent of total billed charges,24% of total billed charges ,29.64,24,,,percent of total billed charges,24% of total billed charges ,29.64,98.8,
GLYCERIN SUPPOSITORY (ADULT),7005762,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
MYSOLINE (PRIMIDONE) 250MG TAB,7005768,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ESMOLOL 2000MG/100ML : IVPB,7005802,CDM,250,RC,,,Outpatient,,,2136,1068,,573.73,26.86,,,percent of total billed charges,26.86% of total billed charges,1602,75,,,percent of total billed charges,75% of total billed charges ,1602,75,,,percent of total billed charges,75% of total billed charges ,512.64,24,,,percent of total billed charges,24% of total billed charges ,1602,75,,,percent of total billed charges,75% of total billed charges ,1602,75,,,percent of total billed charges,75% of total billed charges ,1708.8,80,,,percent of total billed charges,80% of total billed charges ,517.77,24.24,,,percent of total billed charges,24.24% of total billed charges ,1076.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,1602,75,,,percent of total billed charges,75% of total billed charges ,522.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,573.73,26.86,,,percent of total billed charges,26.86% of total billed charges,512.64,24,,,percent of total billed charges,24% of total billed charges ,666.43,31.2,,,percent of total billed charges,31.2% of total billed charges,1708.8,80,,,percent of total billed charges,80% of total billed charges,512.64,24,,,percent of total billed charges,24% of total billed charges ,512.64,24,,,percent of total billed charges,24% of total billed charges ,512.64,1708.8,
ACETAMINOPHEN IVPB 1000MG/100ML(10MG/ML),7005854,CDM,636,RC,J0134,HCPCS,Outpatient,,,90.5,45.25,,24.31,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,72.4,80,,,percent of total billed charges,80% of total billed charges ,21.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,45.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,67.88,75,,,percent of total billed charges,75% of total billed charges ,22.15,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.31,26.86,,,percent of total billed charges,26.86% of total billed charges,21.72,24,,,percent of total billed charges,24% of total billed charges ,28.24,31.2,,,percent of total billed charges,31.2% of total billed charges,72.4,80,,,percent of total billed charges,80% of total billed charges,21.72,24,,,percent of total billed charges,24% of total billed charges ,21.72,24,,,percent of total billed charges,24% of total billed charges ,21.72,72.4,
BACTERIOSTATIC WATER 30ML,7005871,CDM,272,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ENTRESTO 24/26MG TABLET,7005883,CDM,250,RC,,,Outpatient,,,73.25,36.63,,19.67,26.86,,,percent of total billed charges,26.86% of total billed charges,54.94,75,,,percent of total billed charges,75% of total billed charges ,54.94,75,,,percent of total billed charges,75% of total billed charges ,17.58,24,,,percent of total billed charges,24% of total billed charges ,54.94,75,,,percent of total billed charges,75% of total billed charges ,54.94,75,,,percent of total billed charges,75% of total billed charges ,58.6,80,,,percent of total billed charges,80% of total billed charges ,17.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.94,75,,,percent of total billed charges,75% of total billed charges ,17.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.67,26.86,,,percent of total billed charges,26.86% of total billed charges,17.58,24,,,percent of total billed charges,24% of total billed charges ,22.85,31.2,,,percent of total billed charges,31.2% of total billed charges,58.6,80,,,percent of total billed charges,80% of total billed charges,17.58,24,,,percent of total billed charges,24% of total billed charges ,17.58,24,,,percent of total billed charges,24% of total billed charges ,17.58,58.6,
"LIDOCAINE-EPI 2% 1:100,000 INJ 30ML",7005919,CDM,250,RC,,,Outpatient,,,39,19.5,,10.48,26.86,,,percent of total billed charges,26.86% of total billed charges,29.25,75,,,percent of total billed charges,75% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,9.36,24,,,percent of total billed charges,24% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,31.2,80,,,percent of total billed charges,80% of total billed charges ,9.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,9.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.48,26.86,,,percent of total billed charges,26.86% of total billed charges,9.36,24,,,percent of total billed charges,24% of total billed charges ,12.17,31.2,,,percent of total billed charges,31.2% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,9.36,24,,,percent of total billed charges,24% of total billed charges ,9.36,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,
FLORANEX (LACTOBACILLUS) TAB,7005988,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
STERILE WATER IRRIGATION 500ML BOT,7005998,CDM,250,RC,,,Outpatient,,,43.5,21.75,,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,34.8,80,,,percent of total billed charges,80% of total billed charges ,10.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,10.44,24,,,percent of total billed charges,24% of total billed charges ,13.57,31.2,,,percent of total billed charges,31.2% of total billed charges,34.8,80,,,percent of total billed charges,80% of total billed charges,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,34.8,
CUBICIN/NS IVPB 600MG/100ML,7006031,CDM,636,RC,J0878,HCPCS,Outpatient,,,,,,0.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.04,0.04,
ROMAZICON (FLUMAZENIL) 0.1MG/ML (10ML),7006051,CDM,250,RC,,,Outpatient,,,100.5,50.25,,26.99,26.86,,,percent of total billed charges,26.86% of total billed charges,75.38,75,,,percent of total billed charges,75% of total billed charges ,75.38,75,,,percent of total billed charges,75% of total billed charges ,24.12,24,,,percent of total billed charges,24% of total billed charges ,75.38,75,,,percent of total billed charges,75% of total billed charges ,75.38,75,,,percent of total billed charges,75% of total billed charges ,80.4,80,,,percent of total billed charges,80% of total billed charges ,24.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.38,75,,,percent of total billed charges,75% of total billed charges ,24.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.99,26.86,,,percent of total billed charges,26.86% of total billed charges,24.12,24,,,percent of total billed charges,24% of total billed charges ,31.36,31.2,,,percent of total billed charges,31.2% of total billed charges,80.4,80,,,percent of total billed charges,80% of total billed charges,24.12,24,,,percent of total billed charges,24% of total billed charges ,24.12,24,,,percent of total billed charges,24% of total billed charges ,24.12,80.4,
CLEOCIN 600MG/4ML INJ VIAL,7006055,CDM,250,RC,,,Outpatient,,,50.5,25.25,,13.56,26.86,,,percent of total billed charges,26.86% of total billed charges,37.88,75,,,percent of total billed charges,75% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,12.12,24,,,percent of total billed charges,24% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,40.4,80,,,percent of total billed charges,80% of total billed charges ,12.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,12.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.56,26.86,,,percent of total billed charges,26.86% of total billed charges,12.12,24,,,percent of total billed charges,24% of total billed charges ,15.76,31.2,,,percent of total billed charges,31.2% of total billed charges,40.4,80,,,percent of total billed charges,80% of total billed charges,12.12,24,,,percent of total billed charges,24% of total billed charges ,12.12,24,,,percent of total billed charges,24% of total billed charges ,12.12,40.4,
EFFEXOR XR (VENLAFAXINE ER) 150MG CP,7006068,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
CYANOKIT (HYDROXOCOBALAMIN) 5GM,7006092,CDM,636,RC,,,Outpatient,,,4526,2263,,1215.68,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1086.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3620.8,80,,,percent of total billed charges,80% of total billed charges ,1097.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,2281.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,3394.5,75,,,percent of total billed charges,75% of total billed charges ,1107.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,1215.68,26.86,,,percent of total billed charges,26.86% of total billed charges,1086.24,24,,,percent of total billed charges,24% of total billed charges ,1412.11,31.2,,,percent of total billed charges,31.2% of total billed charges,3620.8,80,,,percent of total billed charges,80% of total billed charges,1086.24,24,,,percent of total billed charges,24% of total billed charges ,1086.24,24,,,percent of total billed charges,24% of total billed charges ,1086.24,3620.8,
FLUZONE QUAD(INFLUENZA)0.5ML 23-24,7006106,CDM,636,RC,90686,HCPCS,Outpatient,,,121.5,60.75,,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,97.2,80,,,percent of total billed charges,80% of total billed charges ,29.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.16,24,,,percent of total billed charges,24% of total billed charges ,37.91,31.2,,,percent of total billed charges,31.2% of total billed charges,97.2,80,,,percent of total billed charges,80% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,22.35,97.2,
FLUZONE HI-DOSE(INFLUENZA)0.7ML 23-24,7006107,CDM,636,RC,90662,HCPCS,Outpatient,,,363.5,181.75,,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,87.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,290.8,80,,,percent of total billed charges,80% of total billed charges ,88.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,183.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,272.63,75,,,percent of total billed charges,75% of total billed charges ,88.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,87.24,24,,,percent of total billed charges,24% of total billed charges ,113.41,31.2,,,percent of total billed charges,31.2% of total billed charges,290.8,80,,,percent of total billed charges,80% of total billed charges,87.24,24,,,percent of total billed charges,24% of total billed charges ,87.24,24,,,percent of total billed charges,24% of total billed charges ,73.4,290.8,
ZZZCORTROSYN 0.25MG INJ,7006125,CDM,636,RC,,,Outpatient,,,232,116,,62.32,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.6,80,,,percent of total billed charges,80% of total billed charges ,56.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,116.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,174,75,,,percent of total billed charges,75% of total billed charges ,56.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,62.32,26.86,,,percent of total billed charges,26.86% of total billed charges,55.68,24,,,percent of total billed charges,24% of total billed charges ,72.38,31.2,,,percent of total billed charges,31.2% of total billed charges,185.6,80,,,percent of total billed charges,80% of total billed charges,55.68,24,,,percent of total billed charges,24% of total billed charges ,55.68,24,,,percent of total billed charges,24% of total billed charges ,55.68,185.6,
POTASSIUM PHOSPHATE 15MM/ML INJ (5ML),7006133,CDM,250,RC,,,Outpatient,,,146,73,,39.22,26.86,,,percent of total billed charges,26.86% of total billed charges,109.5,75,,,percent of total billed charges,75% of total billed charges ,109.5,75,,,percent of total billed charges,75% of total billed charges ,35.04,24,,,percent of total billed charges,24% of total billed charges ,109.5,75,,,percent of total billed charges,75% of total billed charges ,109.5,75,,,percent of total billed charges,75% of total billed charges ,116.8,80,,,percent of total billed charges,80% of total billed charges ,35.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,73.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,109.5,75,,,percent of total billed charges,75% of total billed charges ,35.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,39.22,26.86,,,percent of total billed charges,26.86% of total billed charges,35.04,24,,,percent of total billed charges,24% of total billed charges ,45.55,31.2,,,percent of total billed charges,31.2% of total billed charges,116.8,80,,,percent of total billed charges,80% of total billed charges,35.04,24,,,percent of total billed charges,24% of total billed charges ,35.04,24,,,percent of total billed charges,24% of total billed charges ,35.04,116.8,
"LIDOCAINE-EPI 1% 1:100,000 INJ 50ML",7006257,CDM,250,RC,,,Outpatient,,,67.5,33.75,,18.13,26.86,,,percent of total billed charges,26.86% of total billed charges,50.63,75,,,percent of total billed charges,75% of total billed charges ,50.63,75,,,percent of total billed charges,75% of total billed charges ,16.2,24,,,percent of total billed charges,24% of total billed charges ,50.63,75,,,percent of total billed charges,75% of total billed charges ,50.63,75,,,percent of total billed charges,75% of total billed charges ,54,80,,,percent of total billed charges,80% of total billed charges ,16.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.63,75,,,percent of total billed charges,75% of total billed charges ,16.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.13,26.86,,,percent of total billed charges,26.86% of total billed charges,16.2,24,,,percent of total billed charges,24% of total billed charges ,21.06,31.2,,,percent of total billed charges,31.2% of total billed charges,54,80,,,percent of total billed charges,80% of total billed charges,16.2,24,,,percent of total billed charges,24% of total billed charges ,16.2,24,,,percent of total billed charges,24% of total billed charges ,16.2,54,
PHENERGAN (PROMETHAZINE) 50 MG/ML IM,7006259,CDM,636,RC,J2550,HCPCS,Outpatient,,,34,17,,3.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,3.59,27.2,
HYPERTONIC  INH (3%SODIUM CHL)4ML NEB,7006286,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
NIX (PERMETHRINE)CREME RINSE,7006350,CDM,250,RC,,,Outpatient,,,81,40.5,,21.76,26.86,,,percent of total billed charges,26.86% of total billed charges,60.75,75,,,percent of total billed charges,75% of total billed charges ,60.75,75,,,percent of total billed charges,75% of total billed charges ,19.44,24,,,percent of total billed charges,24% of total billed charges ,60.75,75,,,percent of total billed charges,75% of total billed charges ,60.75,75,,,percent of total billed charges,75% of total billed charges ,64.8,80,,,percent of total billed charges,80% of total billed charges ,19.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,40.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,60.75,75,,,percent of total billed charges,75% of total billed charges ,19.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.76,26.86,,,percent of total billed charges,26.86% of total billed charges,19.44,24,,,percent of total billed charges,24% of total billed charges ,25.27,31.2,,,percent of total billed charges,31.2% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,19.44,24,,,percent of total billed charges,24% of total billed charges ,19.44,24,,,percent of total billed charges,24% of total billed charges ,19.44,64.8,
LEXISCAN 0.8MG/ML (5ML),7006393,CDM,250,RC,,,Outpatient,,,1184.5,592.25,,318.16,26.86,,,percent of total billed charges,26.86% of total billed charges,888.38,75,,,percent of total billed charges,75% of total billed charges ,888.38,75,,,percent of total billed charges,75% of total billed charges ,284.28,24,,,percent of total billed charges,24% of total billed charges ,888.38,75,,,percent of total billed charges,75% of total billed charges ,888.38,75,,,percent of total billed charges,75% of total billed charges ,947.6,80,,,percent of total billed charges,80% of total billed charges ,287.12,24.24,,,percent of total billed charges,24.24% of total billed charges ,596.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,888.38,75,,,percent of total billed charges,75% of total billed charges ,289.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,318.16,26.86,,,percent of total billed charges,26.86% of total billed charges,284.28,24,,,percent of total billed charges,24% of total billed charges ,369.56,31.2,,,percent of total billed charges,31.2% of total billed charges,947.6,80,,,percent of total billed charges,80% of total billed charges,284.28,24,,,percent of total billed charges,24% of total billed charges ,284.28,24,,,percent of total billed charges,24% of total billed charges ,284.28,947.6,
CUBICIN/NS IVPB 750MG/100ML,7006416,CDM,636,RC,J0878,HCPCS,Outpatient,,,,,,0.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.04,0.04,
INSULIN-REGULAR (HUMULIN R) 300U/3ML,7006488,CDM,636,RC,J1817,HCPCS,Outpatient,,,1,0.5,,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.8,80,,,percent of total billed charges,80% of total billed charges ,0.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,0.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.31,31.2,,,percent of total billed charges,31.2% of total billed charges,0.8,80,,,percent of total billed charges,80% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,0.8,
INSULIN-N (HUMULIN N) 1000U/10ML,7006514,CDM,636,RC,J1817,HCPCS,Outpatient,,,11.4,5.7,,3.06,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.74,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.12,80,,,percent of total billed charges,80% of total billed charges ,2.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,8.55,75,,,percent of total billed charges,75% of total billed charges ,2.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.06,26.86,,,percent of total billed charges,26.86% of total billed charges,2.74,24,,,percent of total billed charges,24% of total billed charges ,3.56,31.2,,,percent of total billed charges,31.2% of total billed charges,9.12,80,,,percent of total billed charges,80% of total billed charges,2.74,24,,,percent of total billed charges,24% of total billed charges ,2.74,24,,,percent of total billed charges,24% of total billed charges ,2.74,9.12,
VORICONAZOLE 200MG INJ,7006544,CDM,636,RC,J3465,HCPCS,Outpatient,,,335.25,167.63,,90.05,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.46,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,268.2,80,,,percent of total billed charges,80% of total billed charges ,81.26,24.24,,,percent of total billed charges,24.24% of total billed charges ,168.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,251.44,75,,,percent of total billed charges,75% of total billed charges ,82.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,90.05,26.86,,,percent of total billed charges,26.86% of total billed charges,80.46,24,,,percent of total billed charges,24% of total billed charges ,104.6,31.2,,,percent of total billed charges,31.2% of total billed charges,268.2,80,,,percent of total billed charges,80% of total billed charges,80.46,24,,,percent of total billed charges,24% of total billed charges ,80.46,24,,,percent of total billed charges,24% of total billed charges ,80.46,268.2,
INSULIN-RAPID (HUMALOG) VIAL 3ML,7006558,CDM,636,RC,J1817,HCPCS,Outpatient,,,1,0.5,,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.8,80,,,percent of total billed charges,80% of total billed charges ,0.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,0.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.31,31.2,,,percent of total billed charges,31.2% of total billed charges,0.8,80,,,percent of total billed charges,80% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,0.8,
MOTRIN (IBUPROFEN) 100MG/5ML LIQ UD,7011017,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ZZZATARAX (HYDROXYZINE HCL) 10MG/5ML SYR,7011019,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
BENADRYL (DIPHENHYDRAMINE) 25MG/10ML,7011040,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ORACIT (CITRIC ACID/SOD) 30ML UD,7011069,CDM,250,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
CHARCOAL  50GM/240ML SUS,7011082,CDM,250,RC,,,Outpatient,,,200,100,,53.72,26.86,,,percent of total billed charges,26.86% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges ,150,75,,,percent of total billed charges,75% of total billed charges ,48,24,,,percent of total billed charges,24% of total billed charges ,150,75,,,percent of total billed charges,75% of total billed charges ,150,75,,,percent of total billed charges,75% of total billed charges ,160,80,,,percent of total billed charges,80% of total billed charges ,48.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,150,75,,,percent of total billed charges,75% of total billed charges ,48.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,53.72,26.86,,,percent of total billed charges,26.86% of total billed charges,48,24,,,percent of total billed charges,24% of total billed charges ,62.4,31.2,,,percent of total billed charges,31.2% of total billed charges,160,80,,,percent of total billed charges,80% of total billed charges,48,24,,,percent of total billed charges,24% of total billed charges ,48,24,,,percent of total billed charges,24% of total billed charges ,48,160,
CARAFATE (SUCRALFATE) 1GM/10ML LIQ,7011093,CDM,250,RC,,,Outpatient,,,70,35,,18.8,26.86,,,percent of total billed charges,26.86% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,16.8,24,,,percent of total billed charges,24% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,56,80,,,percent of total billed charges,80% of total billed charges ,16.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,17.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.8,26.86,,,percent of total billed charges,26.86% of total billed charges,16.8,24,,,percent of total billed charges,24% of total billed charges ,21.84,31.2,,,percent of total billed charges,31.2% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,16.8,24,,,percent of total billed charges,24% of total billed charges ,16.8,24,,,percent of total billed charges,24% of total billed charges ,16.8,56,
DECADRON (DEXAMETHASONE) 0.5MG/5ML,7011143,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZTEFLARO (CEFTAROLINE FOS) 600MG IV,7011156,CDM,636,RC,J0712,HCPCS,Outpatient,,,801.5,400.75,,215.28,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,192.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,641.2,80,,,percent of total billed charges,80% of total billed charges ,194.28,24.24,,,percent of total billed charges,24.24% of total billed charges ,403.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,601.13,75,,,percent of total billed charges,75% of total billed charges ,196.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,215.28,26.86,,,percent of total billed charges,26.86% of total billed charges,192.36,24,,,percent of total billed charges,24% of total billed charges ,250.07,31.2,,,percent of total billed charges,31.2% of total billed charges,641.2,80,,,percent of total billed charges,80% of total billed charges,192.36,24,,,percent of total billed charges,24% of total billed charges ,192.36,24,,,percent of total billed charges,24% of total billed charges ,192.36,641.2,
DILANTIN (PHENYTOIN) 100MG/4ML SUS UD,7011163,CDM,250,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
ZZZEMETROL (DEXT/LEVULOSE/PHOS) SOLN,7011237,CDM,250,RC,,,Outpatient,,,8,4,,2.15,26.86,,,percent of total billed charges,26.86% of total billed charges,6,75,,,percent of total billed charges,75% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,6.4,80,,,percent of total billed charges,80% of total billed charges ,1.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.15,26.86,,,percent of total billed charges,26.86% of total billed charges,1.92,24,,,percent of total billed charges,24% of total billed charges ,2.5,31.2,,,percent of total billed charges,31.2% of total billed charges,6.4,80,,,percent of total billed charges,80% of total billed charges,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,6.4,
FERROUS SULFATE 220MG (44MG IRON)/5ML OR,7011246,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZHALDOL CONC (HALOP LAC) 2MG/ML 15ML,7011292,CDM,636,RC,J1630,HCPCS,Outpatient,,,203,101.5,,1.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,162.4,80,,,percent of total billed charges,80% of total billed charges ,49.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,102.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,152.25,75,,,percent of total billed charges,75% of total billed charges ,49.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,48.72,24,,,percent of total billed charges,24% of total billed charges ,63.34,31.2,,,percent of total billed charges,31.2% of total billed charges,162.4,80,,,percent of total billed charges,80% of total billed charges,48.72,24,,,percent of total billed charges,24% of total billed charges ,48.72,24,,,percent of total billed charges,24% of total billed charges ,1.42,162.4,
POTASSIUM CHLOR 20% 40MEQ/15ML,7011328,CDM,250,RC,,,Outpatient,,,71,35.5,,19.07,26.86,,,percent of total billed charges,26.86% of total billed charges,53.25,75,,,percent of total billed charges,75% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,56.8,80,,,percent of total billed charges,80% of total billed charges ,17.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.07,26.86,,,percent of total billed charges,26.86% of total billed charges,17.04,24,,,percent of total billed charges,24% of total billed charges ,22.15,31.2,,,percent of total billed charges,31.2% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,17.04,24,,,percent of total billed charges,24% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,17.04,56.8,
KAYEXALATE (SPS) 15GM/60ML SUS,7011337,CDM,250,RC,,,Outpatient,,,66,33,,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,52.8,80,,,percent of total billed charges,80% of total billed charges ,16,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,16.16,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,20.59,31.2,,,percent of total billed charges,31.2% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,52.8,
MINERAL OIL LAXATIVE 30ML,7011346,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZLANOXIN (DIGOXIN) 0.05MG/ML SOLN,7011364,CDM,259,RC,,,Outpatient,,,704.5,352.25,,189.23,26.86,,,percent of total billed charges,26.86% of total billed charges,528.38,75,,,percent of total billed charges,75% of total billed charges ,528.38,75,,,percent of total billed charges,75% of total billed charges ,169.08,24,,,percent of total billed charges,24% of total billed charges ,528.38,75,,,percent of total billed charges,75% of total billed charges ,528.38,75,,,percent of total billed charges,75% of total billed charges ,563.6,80,,,percent of total billed charges,80% of total billed charges ,170.77,24.24,,,percent of total billed charges,24.24% of total billed charges ,355.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,528.38,75,,,percent of total billed charges,75% of total billed charges ,172.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,189.23,26.86,,,percent of total billed charges,26.86% of total billed charges,169.08,24,,,percent of total billed charges,24% of total billed charges ,219.8,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,169.08,24,,,percent of total billed charges,24% of total billed charges ,169.08,24,,,percent of total billed charges,24% of total billed charges ,169.08,563.6,
LASIX (FUROSEMIDE) 10MG/ML 60ML SOL,7011374,CDM,250,RC,,,Outpatient,,,62,31,,16.65,26.86,,,percent of total billed charges,26.86% of total billed charges,46.5,75,,,percent of total billed charges,75% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,14.88,24,,,percent of total billed charges,24% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,49.6,80,,,percent of total billed charges,80% of total billed charges ,15.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,15.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.65,26.86,,,percent of total billed charges,26.86% of total billed charges,14.88,24,,,percent of total billed charges,24% of total billed charges ,19.34,31.2,,,percent of total billed charges,31.2% of total billed charges,49.6,80,,,percent of total billed charges,80% of total billed charges,14.88,24,,,percent of total billed charges,24% of total billed charges ,14.88,24,,,percent of total billed charges,24% of total billed charges ,14.88,49.6,
LEVSIN (HYOSCYAM) 0.125MG/ML DROPS,7011392,CDM,250,RC,,,Outpatient,,,202,101,,54.26,26.86,,,percent of total billed charges,26.86% of total billed charges,151.5,75,,,percent of total billed charges,75% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,48.48,24,,,percent of total billed charges,24% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,161.6,80,,,percent of total billed charges,80% of total billed charges ,48.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,101.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,49.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,54.26,26.86,,,percent of total billed charges,26.86% of total billed charges,48.48,24,,,percent of total billed charges,24% of total billed charges ,63.02,31.2,,,percent of total billed charges,31.2% of total billed charges,161.6,80,,,percent of total billed charges,80% of total billed charges,48.48,24,,,percent of total billed charges,24% of total billed charges ,48.48,24,,,percent of total billed charges,24% of total billed charges ,48.48,161.6,
LEVSIN (HYOSCYAMINE 0.125MG/5ML) ELIX,7011393,CDM,636,RC,J1980,HCPCS,Outpatient,,,15.5,7.75,,35.46,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.46,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,35.46,
LOMOTIL LIQ (DIPHENOX/ATR 2.5/0.025) 5ML,7011410,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZLORTAB ELIX(HYDR/APAP) 3.33/100MG 5ML,7011413,CDM,250,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
PEDIAPRED (PREDNISOLONE) 5 MG/5 ML UD,7011494,CDM,250,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
"NYSTATIN 100,000U/ML 5ML SUSP",7011510,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
PEPCID (FAMOTID) 40MG/5ML ORAL SUSP,7011551,CDM,250,RC,,,Outpatient,,,588,294,,157.94,26.86,,,percent of total billed charges,26.86% of total billed charges,441,75,,,percent of total billed charges,75% of total billed charges ,441,75,,,percent of total billed charges,75% of total billed charges ,141.12,24,,,percent of total billed charges,24% of total billed charges ,441,75,,,percent of total billed charges,75% of total billed charges ,441,75,,,percent of total billed charges,75% of total billed charges ,470.4,80,,,percent of total billed charges,80% of total billed charges ,142.53,24.24,,,percent of total billed charges,24.24% of total billed charges ,296.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,441,75,,,percent of total billed charges,75% of total billed charges ,143.94,24.48,,,percent of total billed charges,24.48% of total billed charges ,157.94,26.86,,,percent of total billed charges,26.86% of total billed charges,141.12,24,,,percent of total billed charges,24% of total billed charges ,183.46,31.2,,,percent of total billed charges,31.2% of total billed charges,470.4,80,,,percent of total billed charges,80% of total billed charges,141.12,24,,,percent of total billed charges,24% of total billed charges ,141.12,24,,,percent of total billed charges,24% of total billed charges ,141.12,470.4,
PHENERGAN (PROMETH) 6.25MG/5ML ORAL SYRU,7011555,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
PEPTO-BISMOL (BISMUTH SUBS) 30ML,7011564,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
PHENERGAN/COD (PROM/COD) 5ML SYR,7011573,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ROBITUSSIN DM (DM/GUA) 20/200MG/10ML,7011629,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
SYMMETREL (AMANTADINE) 50MG/5ML,7011655,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
AUGMENTIN (AMOX/CLAV) 200MG/5ML SUS,7011706,CDM,250,RC,,,Outpatient,,,100,50,,26.86,26.86,,,percent of total billed charges,26.86% of total billed charges,75,75,,,percent of total billed charges,75% of total billed charges ,75,75,,,percent of total billed charges,75% of total billed charges ,24,24,,,percent of total billed charges,24% of total billed charges ,75,75,,,percent of total billed charges,75% of total billed charges ,75,75,,,percent of total billed charges,75% of total billed charges ,80,80,,,percent of total billed charges,80% of total billed charges ,24.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,75,75,,,percent of total billed charges,75% of total billed charges ,24.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24,24,,,percent of total billed charges,24% of total billed charges ,31.2,31.2,,,percent of total billed charges,31.2% of total billed charges,80,80,,,percent of total billed charges,80% of total billed charges,24,24,,,percent of total billed charges,24% of total billed charges ,24,24,,,percent of total billed charges,24% of total billed charges ,24,80,
KEFLEX (CEPHALEXIN) 250MG/5ML SUSP,7011782,CDM,250,RC,,,Outpatient,,,149.5,74.75,,40.16,26.86,,,percent of total billed charges,26.86% of total billed charges,112.13,75,,,percent of total billed charges,75% of total billed charges ,112.13,75,,,percent of total billed charges,75% of total billed charges ,35.88,24,,,percent of total billed charges,24% of total billed charges ,112.13,75,,,percent of total billed charges,75% of total billed charges ,112.13,75,,,percent of total billed charges,75% of total billed charges ,119.6,80,,,percent of total billed charges,80% of total billed charges ,36.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,75.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,112.13,75,,,percent of total billed charges,75% of total billed charges ,36.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,40.16,26.86,,,percent of total billed charges,26.86% of total billed charges,35.88,24,,,percent of total billed charges,24% of total billed charges ,46.64,31.2,,,percent of total billed charges,31.2% of total billed charges,119.6,80,,,percent of total billed charges,80% of total billed charges,35.88,24,,,percent of total billed charges,24% of total billed charges ,35.88,24,,,percent of total billed charges,24% of total billed charges ,35.88,119.6,
ERYPED (ERYTHROMYCIN/SULF) 200MG SUS,7011791,CDM,250,RC,,,Outpatient,,,457.5,228.75,,122.88,26.86,,,percent of total billed charges,26.86% of total billed charges,343.13,75,,,percent of total billed charges,75% of total billed charges ,343.13,75,,,percent of total billed charges,75% of total billed charges ,109.8,24,,,percent of total billed charges,24% of total billed charges ,343.13,75,,,percent of total billed charges,75% of total billed charges ,343.13,75,,,percent of total billed charges,75% of total billed charges ,366,80,,,percent of total billed charges,80% of total billed charges ,110.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,230.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,343.13,75,,,percent of total billed charges,75% of total billed charges ,112,24.48,,,percent of total billed charges,24.48% of total billed charges ,122.88,26.86,,,percent of total billed charges,26.86% of total billed charges,109.8,24,,,percent of total billed charges,24% of total billed charges ,142.74,31.2,,,percent of total billed charges,31.2% of total billed charges,366,80,,,percent of total billed charges,80% of total billed charges,109.8,24,,,percent of total billed charges,24% of total billed charges ,109.8,24,,,percent of total billed charges,24% of total billed charges ,109.8,366,
SEPTRA (SMZ/TMP 800/160MG) 20ML SUS,7011824,CDM,250,RC,,,Outpatient,,,55.5,27.75,,14.91,26.86,,,percent of total billed charges,26.86% of total billed charges,41.63,75,,,percent of total billed charges,75% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,13.32,24,,,percent of total billed charges,24% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,44.4,80,,,percent of total billed charges,80% of total billed charges ,13.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,27.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,13.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.91,26.86,,,percent of total billed charges,26.86% of total billed charges,13.32,24,,,percent of total billed charges,24% of total billed charges ,17.32,31.2,,,percent of total billed charges,31.2% of total billed charges,44.4,80,,,percent of total billed charges,80% of total billed charges,13.32,24,,,percent of total billed charges,24% of total billed charges ,13.32,24,,,percent of total billed charges,24% of total billed charges ,13.32,44.4,
AMPHOJEL (ALUM HYD GEL) LIQ,7011864,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZGAVISCON (AL HYDROX) SUSP,7011891,CDM,250,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
MAGNESIUM CITRATE SOLUTION 300ML,7011898,CDM,250,RC,,,Outpatient,,,17.5,8.75,,4.7,26.86,,,percent of total billed charges,26.86% of total billed charges,13.13,75,,,percent of total billed charges,75% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,4.2,24,,,percent of total billed charges,24% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,14,80,,,percent of total billed charges,80% of total billed charges ,4.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,4.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.7,26.86,,,percent of total billed charges,26.86% of total billed charges,4.2,24,,,percent of total billed charges,24% of total billed charges ,5.46,31.2,,,percent of total billed charges,31.2% of total billed charges,14,80,,,percent of total billed charges,80% of total billed charges,4.2,24,,,percent of total billed charges,24% of total billed charges ,4.2,24,,,percent of total billed charges,24% of total billed charges ,4.2,14,
ZZZZOCOR (SIMVASTATIN) 20MG TAB,7011991,CDM,250,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
TORADOL (KETOROLAC) 10MG TAB,7014753,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ZZZNF-ACCUPRIL (QUINAPRIL) 10MG TAB,7015003,CDM,250,RC,,,Outpatient,,,10.5,5.25,,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,8.4,80,,,percent of total billed charges,80% of total billed charges ,2.55,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,3.28,31.2,,,percent of total billed charges,31.2% of total billed charges,8.4,80,,,percent of total billed charges,80% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,8.4,
ZZZACTIGALL (URSODIOL) 300MG CAP,7015004,CDM,250,RC,,,Outpatient,,,54.5,27.25,,14.64,26.86,,,percent of total billed charges,26.86% of total billed charges,40.88,75,,,percent of total billed charges,75% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,13.08,24,,,percent of total billed charges,24% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,43.6,80,,,percent of total billed charges,80% of total billed charges ,13.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,27.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,13.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.64,26.86,,,percent of total billed charges,26.86% of total billed charges,13.08,24,,,percent of total billed charges,24% of total billed charges ,17,31.2,,,percent of total billed charges,31.2% of total billed charges,43.6,80,,,percent of total billed charges,80% of total billed charges,13.08,24,,,percent of total billed charges,24% of total billed charges ,13.08,24,,,percent of total billed charges,24% of total billed charges ,13.08,43.6,
ALDACTONE (SPIRONOLACTONE) 25MG TAB,7015030,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ALLBEE+C (B COMPEX W/C) TAB,7015110,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
NF-ALTACE (RAMIPRIL) 2.5MG CAP,7015115,CDM,250,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
ALTACE (RAMIPRIL) 5MG CAP-NF,7015116,CDM,250,RC,,,Outpatient,,,11.5,5.75,,3.09,26.86,,,percent of total billed charges,26.86% of total billed charges,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,9.2,80,,,percent of total billed charges,80% of total billed charges ,2.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,8.63,75,,,percent of total billed charges,75% of total billed charges ,2.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.09,26.86,,,percent of total billed charges,26.86% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,3.59,31.2,,,percent of total billed charges,31.2% of total billed charges,9.2,80,,,percent of total billed charges,80% of total billed charges,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,24,,,percent of total billed charges,24% of total billed charges ,2.76,9.2,
AMBIEN (ZOLPIDEM) 5MG TAB,7015121,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
AMPICILLLIN 250MG CAP,7015133,CDM,250,RC,,,Outpatient,,,8,4,,2.15,26.86,,,percent of total billed charges,26.86% of total billed charges,6,75,,,percent of total billed charges,75% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,6.4,80,,,percent of total billed charges,80% of total billed charges ,1.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.15,26.86,,,percent of total billed charges,26.86% of total billed charges,1.92,24,,,percent of total billed charges,24% of total billed charges ,2.5,31.2,,,percent of total billed charges,31.2% of total billed charges,6.4,80,,,percent of total billed charges,80% of total billed charges,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,6.4,
AMOXICILLIN 250MG CAP,7015160,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
AMOXICILLIN 500MG TAB,7015170,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ANTIVERT (MECLIZINE) 25MG TAB,7015200,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ANTIVERT (MECLIZINE) 12.5MG TAB,7015210,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZANTABUSE (DISULFIRAM) 250MG TAB,7015220,CDM,250,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
APRESOLINE (HYDRALAZINE) 10MG TAB,7015240,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
APRESOLINE (HYDRALAZINE) 25MG TAB,7015250,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
VITAMIN C (ASCORBIC ACID) 500MG TAB,7015310,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ASPIRIN 325MG TAB E.C.,7015340,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ASPIRIN 325MG TAB,7015360,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ASPIRIN 81MG TAB E.C.,7015364,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ASPIRIN 81MG CHEWABLE TAB,7015370,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ATIVAN (LORAZEPAM) 0.5MG TAB,7015418,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ATARAX (HYDROXYZINE HCL) 25MG TAB,7015460,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
AUGMENTIN (AMOX/CLAV) 250/125 TAB,7015470,CDM,250,RC,,,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
AUGMENTIN (AMOX/CLAV) 500/125 TAB,7015480,CDM,250,RC,,,Outpatient,,,30,15,,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,24,80,,,percent of total billed charges,80% of total billed charges ,7.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,,,percent of total billed charges,31.2% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,
SULFAZINE (SULFASALAZINE) 500MG TAB,7015500,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
BENADRYL (DIPHENHYDRAMINE) 25MG TAB,7015530,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
BENTYL (DICYCLOMINE) 10MG CAP,7015550,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
BETAPACE (SOTALOL) 80MG TAB,7015565,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
BIAXIN (CLARITHROMYCIN) 250MG TAB,7015583,CDM,250,RC,,,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
BRETHINE (TERBUTALINE) 5MG TAB,7015590,CDM,250,RC,,,Outpatient,,,42,21,,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,33.6,80,,,percent of total billed charges,80% of total billed charges ,10.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,13.1,31.2,,,percent of total billed charges,31.2% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,33.6,
BUMEX (BUMETANIDE) 1MG TAB,7015630,CDM,250,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
BUSPAR (BUSPIRONE) 10MG TAB,7015650,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
CALAN SR (VERAPAMIL ER) 180MG TAB,7015674,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
CARAFATE (SUCRALFATE) 1GM TAB,7015730,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
CARDIZEM (DILTIAZEM) 30MG TAB,7015740,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
CARDIZEM CD (DILTIAZEM) 180MG CAP,7015755,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
CARDIZEM CD (DILTIAZEM) 240MG CAP,7015756,CDM,250,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
CARDIZEM CD (DILTIAZEM) 120MG CAP,7015757,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
CARDURA (DOXAZOSIN) 1MG TAB,7015758,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
CARDURA (DOXAZOSIN) 4MG TAB,7015759,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
CATAPRES (CLONIDINE) 0.1MG TAB,7015760,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
CATAPRES (CLONIDINE) 0.2MG TAB,7015770,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZCATAPRES (CLONIDINE) 0.3MG TAB,7015780,CDM,250,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
CEFTIN (CEFUROXIME) 250MG TAB,7015810,CDM,250,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
CENTRUM (MULTIVITAMIN) TAB,7015850,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
CIPROFLOXACIN 500MG TAB,7015960,CDM,250,RC,,,Outpatient,,,29,14.5,,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,23.2,80,,,percent of total billed charges,80% of total billed charges ,7.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,7.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,9.05,31.2,,,percent of total billed charges,31.2% of total billed charges,23.2,80,,,percent of total billed charges,80% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,23.2,
CLARITIN (LORATIDINE) 10MG TAB,7015977,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
CLEOCIN (CLINDAMYCIN) 150MG CAP,7015980,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
COGENTIN (BENZTROPINE) 0.5MG TAB,7016018,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
COZAAR (LOSARTAN) 50MG TAB,7016027,CDM,250,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
COLACE (DOCUSATE SOD) 100MG CAP,7016030,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
EPHEDRINE 50MG/ML INJ,7016031,CDM,636,RC,J3490,HCPCS,Outpatient,,,180.5,90.25,,48.48,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,43.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,144.4,80,,,percent of total billed charges,80% of total billed charges ,43.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,90.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,44.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,48.48,26.86,,,percent of total billed charges,26.86% of total billed charges,43.32,24,,,percent of total billed charges,24% of total billed charges ,56.32,31.2,,,percent of total billed charges,31.2% of total billed charges,144.4,80,,,percent of total billed charges,80% of total billed charges,43.32,24,,,percent of total billed charges,24% of total billed charges ,43.32,24,,,percent of total billed charges,24% of total billed charges ,43.32,144.4,
COLCHICINE-PROBENECID 0.5MG-500MG TAB,7016040,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
COLCRYS 0.6MG TAB,7016050,CDM,250,RC,,,Outpatient,,,65,32.5,,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,52,80,,,percent of total billed charges,80% of total billed charges ,15.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,15.6,24,,,percent of total billed charges,24% of total billed charges ,20.28,31.2,,,percent of total billed charges,31.2% of total billed charges,52,80,,,percent of total billed charges,80% of total billed charges,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,52,
COMPAZINE (PROCHLORPERAZINE) 5MG TB,7016080,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
CORDARONE (AMIODARONE) 200MG TAB,7016120,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
CORTEF (HYDROCORTISONE) 5MG TAB,7016124,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
COUMADIN (WARFARIN) 1MG TAB,7016128,CDM,250,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
COUMADIN (WARFARIN) 2MG TAB,7016130,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
COUMADIN (WARFARIN) 2.5MG TAB,7016132,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
COUMADIN (WARFARIN) 4MG TAB,7016137,CDM,250,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
COUMADIN (WARFARIN) 5MG TAB,7016140,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ZZZCOUMADIN (WARFARIN) 7.5MG TAB,7016150,CDM,250,RC,,,Outpatient,,,28,14,,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,22.4,80,,,percent of total billed charges,80% of total billed charges ,6.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,8.74,31.2,,,percent of total billed charges,31.2% of total billed charges,22.4,80,,,percent of total billed charges,80% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,22.4,
COGENTIN (BENZTROPINE) 2MG TAB,7016160,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZCOUMADIN (WARFARIN) 10MG TAB,7016170,CDM,250,RC,,,Outpatient,,,29,14.5,,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,23.2,80,,,percent of total billed charges,80% of total billed charges ,7.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,7.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,9.05,31.2,,,percent of total billed charges,31.2% of total billed charges,23.2,80,,,percent of total billed charges,80% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,23.2,
ZZZDANTRIUM (DANTROLENE SOD) 25MG CAP,7016232,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
DEMECLOCYCLINE 150MG TAB,7016238,CDM,250,RC,,,Outpatient,,,102,51,,27.4,26.86,,,percent of total billed charges,26.86% of total billed charges,76.5,75,,,percent of total billed charges,75% of total billed charges ,76.5,75,,,percent of total billed charges,75% of total billed charges ,24.48,24,,,percent of total billed charges,24% of total billed charges ,76.5,75,,,percent of total billed charges,75% of total billed charges ,76.5,75,,,percent of total billed charges,75% of total billed charges ,81.6,80,,,percent of total billed charges,80% of total billed charges ,24.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,51.41,50.4,,,percent of total billed charges,50.4% of total billed charges ,76.5,75,,,percent of total billed charges,75% of total billed charges ,24.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.4,26.86,,,percent of total billed charges,26.86% of total billed charges,24.48,24,,,percent of total billed charges,24% of total billed charges ,31.82,31.2,,,percent of total billed charges,31.2% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,24.48,24,,,percent of total billed charges,24% of total billed charges ,24.48,24,,,percent of total billed charges,24% of total billed charges ,24.48,81.6,
ZZZDECADRON (DEXAMETHASONE) 0.75MG TAB,7016240,CDM,259,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,,,,,Other,Not Separately reimbursable,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
DECADRON (DEXAMETHASONE) 4MG TAB,7016250,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
DEPAKOTE (DIVALPROEX DR) 125MG TAB,7016257,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
DESYREL (TRAZODONE) 50MG TAB,7016260,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
DILANTIN (PHENYTOIN) 100MG CAP,7016310,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
SALSALATE 500MG TAB,7016370,CDM,250,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
DITROPAN (OXYBUTYNIN) 5MG TAB,7016400,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
DULCOLAX (BISACODYL) 5MG TAB,7016500,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
EFFEXOR (VENLAFAXINE) 37.5MG TAB,7016542,CDM,250,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ELAVIL (AMITRIPTYLINE) 10MG TAB,7016567,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ELAVIL (AMITRIPTYLINE) 25MG TAB,7016570,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZELAVIL (AMITRIPTYLINE) 50MG TAB,7016580,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ESTRACE (ESTRADIOL) 1MG TAB,7016625,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
DURICEF (CEFADROXIL) 500MG CAP,7016630,CDM,250,RC,,,Outpatient,,,29,14.5,,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,23.2,80,,,percent of total billed charges,80% of total billed charges ,7.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,7.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,9.05,31.2,,,percent of total billed charges,31.2% of total billed charges,23.2,80,,,percent of total billed charges,80% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,23.2,
ERYTHROMYCIN BASE FILMTAB 250MG,7016660,CDM,250,RC,,,Outpatient,,,52.5,26.25,,14.1,26.86,,,percent of total billed charges,26.86% of total billed charges,39.38,75,,,percent of total billed charges,75% of total billed charges ,39.38,75,,,percent of total billed charges,75% of total billed charges ,12.6,24,,,percent of total billed charges,24% of total billed charges ,39.38,75,,,percent of total billed charges,75% of total billed charges ,39.38,75,,,percent of total billed charges,75% of total billed charges ,42,80,,,percent of total billed charges,80% of total billed charges ,12.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.46,50.4,,,percent of total billed charges,50.4% of total billed charges ,39.38,75,,,percent of total billed charges,75% of total billed charges ,12.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.1,26.86,,,percent of total billed charges,26.86% of total billed charges,12.6,24,,,percent of total billed charges,24% of total billed charges ,16.38,31.2,,,percent of total billed charges,31.2% of total billed charges,42,80,,,percent of total billed charges,80% of total billed charges,12.6,24,,,percent of total billed charges,24% of total billed charges ,12.6,24,,,percent of total billed charges,24% of total billed charges ,12.6,42,
VITAMIN D3 1000 UNIT TAB (25MCG),7016700,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
HYDROCHLOROTHIAZIDE 25MG TAB,7016723,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZFELDENE (PIROXICAM) 20MG CAP,7016770,CDM,250,RC,,,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
FERROUS SULFATE 325MG (IRON 65MG) TAB,7016780,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZFLAGYL (METRONIDAZOLE) 250MG TAB,7016790,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
FLEXERIL (CYCLOBENZAPRINE) 10MG TAB,7016800,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
FLORINEF (FLUDROCORTISONE) 0.1MG TAB,7016806,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
FOLIC ACID 1MG TAB,7016810,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZFOSOMAX (ALENDRONATE) 10MG TAB,7016816,CDM,250,RC,,,Outpatient,,,23.5,11.75,,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,18.8,80,,,percent of total billed charges,80% of total billed charges ,5.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,7.33,31.2,,,percent of total billed charges,31.2% of total billed charges,18.8,80,,,percent of total billed charges,80% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,18.8,
ZZZGLYNASE (GLYBURIDE) 3MG TAB,7016834,CDM,250,RC,,,Outpatient,,,8,4,,2.15,26.86,,,percent of total billed charges,26.86% of total billed charges,6,75,,,percent of total billed charges,75% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,6.4,80,,,percent of total billed charges,80% of total billed charges ,1.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,6,75,,,percent of total billed charges,75% of total billed charges ,1.96,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.15,26.86,,,percent of total billed charges,26.86% of total billed charges,1.92,24,,,percent of total billed charges,24% of total billed charges ,2.5,31.2,,,percent of total billed charges,31.2% of total billed charges,6.4,80,,,percent of total billed charges,80% of total billed charges,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,24,,,percent of total billed charges,24% of total billed charges ,1.92,6.4,
VITAMIN E 200 UNIT CAP,7016844,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
GLUCOTROL (GLIPIZIDE) 5MG TAB,7016878,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
GLUCOPHAGE (METFORMIN) 500MG TAB,7016884,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
HALDOL (HALOPERIDOL) 1MG TAB,7016910,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
HALDOL (HALOPERIDOL) 5MG TAB,7016930,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
MUCINEX (GUAIFENESIN ER) 600MG TAB,7016947,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
HYDREA (HYDROXYUREA) 500MG CAP,7016978,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZHYTRIN (TERAZOSIN) 1MG CAP,7016990,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZHYTRIN (TERAZOSIN) 5MG CAP,7017002,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
HYGROTON (CHLORTHALIDONE) 25MG TAB,7017015,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
IMODIUM (LOPERAMIDE) 2MG CAP,7017050,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZIMURAN (AZATHIOPRINE) 50MG TAB,7017052,CDM,250,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
INDERAL (PROPRANOLOL) 10MG TAB,7017055,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZINDERAL (PROPRANOLOL) 40MG TAB,7017065,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZINDERAL LA (PROPRANOLOL ER) 80MG CAP,7017080,CDM,250,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
INDOCIN (INDOMETHACIN) 25MG CAP,7017120,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
INDOCIN SR (INDOMETHACIN ER) 75MG CAP,7017130,CDM,250,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
ISONIAZIDE 300MG TAB,7017140,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ISORDIL (ISOSORBIDE DIN) 10MG TAB,7017155,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ISMO (ISOSORBIDE MON) 20MG TAB,7017166,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
K-LOR (POTASSIUM CL) 20MEQ TAB,7017168,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
KEFLEX (CEPHALEXIN) 250MG CAP,7017170,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
LANOXIN (DIGOXIN) 0.25MG TAB,7017200,CDM,250,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
LASIX (FUROSEMIDE) 40MG TAB,7017205,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
LASIX (FUROSEMIDE) 20MG TAB,7017215,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
LASIX (FUROSEMIDE) 80MG TAB,7017225,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZLEVSIN (HYOSCYAMINE SULF) 0.125MG TAB,7017234,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZLIBRAX (CHLORDIAZE CLIDINIUM) CAP,7017240,CDM,250,RC,,,Outpatient,,,39,19.5,,10.48,26.86,,,percent of total billed charges,26.86% of total billed charges,29.25,75,,,percent of total billed charges,75% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,9.36,24,,,percent of total billed charges,24% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,31.2,80,,,percent of total billed charges,80% of total billed charges ,9.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,9.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.48,26.86,,,percent of total billed charges,26.86% of total billed charges,9.36,24,,,percent of total billed charges,24% of total billed charges ,12.17,31.2,,,percent of total billed charges,31.2% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,9.36,24,,,percent of total billed charges,24% of total billed charges ,9.36,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,
ZZZLIMBITROL (CHLORD/AMITR) 5-12.5 TAB,7017245,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZLITHIUM CARBONATE 300MG CAP,7017255,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
LONITEN (MINOXIDIL) 10MG TAB,7017260,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
LONITEN (MINOXIDIL) 2.5MG TAB,7017261,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
LOPID (GEMFIBROZIL) 600MG TAB,7017271,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
LOPRESSOR (METOPROLOL) 50MG TAB,7017275,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
LOTENSIN (BENAZEPRIL) 20MG TAB,7017276,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
LOTENSIN (BENAZEPRIL) 10MG TAB,7017277,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
MACRODANTIN (NITROFURANTOIN) 50MG CAP,7017320,CDM,250,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
MAXZIDE (TRIAM-HCTZ 37.5-25MG) TAB,7017339,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
MEDROL (METHYLPREDNISOLONE) 4MG TAB,7017355,CDM,636,RC,J7509,HCPCS,Outpatient,,,17.5,8.75,,4.7,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14,80,,,percent of total billed charges,80% of total billed charges ,4.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,4.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.7,26.86,,,percent of total billed charges,26.86% of total billed charges,4.2,24,,,percent of total billed charges,24% of total billed charges ,5.46,31.2,,,percent of total billed charges,31.2% of total billed charges,14,80,,,percent of total billed charges,80% of total billed charges,4.2,24,,,percent of total billed charges,24% of total billed charges ,4.2,24,,,percent of total billed charges,24% of total billed charges ,4.2,14,
MEGACE (MEGESTEROL) 40MG TAB,7017375,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
MEPHYTON (PHYTONADIONE) 5MG TAB,7017406,CDM,250,RC,,,Outpatient,,,444,222,,119.26,26.86,,,percent of total billed charges,26.86% of total billed charges,333,75,,,percent of total billed charges,75% of total billed charges ,333,75,,,percent of total billed charges,75% of total billed charges ,106.56,24,,,percent of total billed charges,24% of total billed charges ,333,75,,,percent of total billed charges,75% of total billed charges ,333,75,,,percent of total billed charges,75% of total billed charges ,355.2,80,,,percent of total billed charges,80% of total billed charges ,107.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,223.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,333,75,,,percent of total billed charges,75% of total billed charges ,108.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,119.26,26.86,,,percent of total billed charges,26.86% of total billed charges,106.56,24,,,percent of total billed charges,24% of total billed charges ,138.53,31.2,,,percent of total billed charges,31.2% of total billed charges,355.2,80,,,percent of total billed charges,80% of total billed charges,106.56,24,,,percent of total billed charges,24% of total billed charges ,106.56,24,,,percent of total billed charges,24% of total billed charges ,106.56,355.2,
METHADONE 10MG TAB,7017409,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
METHOTREXATE 2.5MG TAB,7017412,CDM,636,RC,J8610,HCPCS,Outpatient,,,41,20.5,,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.8,80,,,percent of total billed charges,80% of total billed charges ,9.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,10.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,12.79,31.2,,,percent of total billed charges,31.2% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,32.8,
METAMUCIL (PSYLLIUM) SF  PACKET,7017425,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
MICRO-K (POTASSIUM CL ER) 10MEQ CAP,7017430,CDM,250,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
ZZZDIABETA (GLYBURIDE) 5MG TAB,7017450,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
MOTRIN (IBUPROFEN) 200MG TAB,7017519,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
MOTRIN (IBUPROFEN) 400MG TAB,7017520,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
MOTRIN (IBUPROFEN) 600MG TAB,7017525,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZMONOPRIL (FOSINOPRIL) 10MG TAB,7017529,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
MOTRIN (IBUPROFEN) 800MG TAB,7017530,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
MYLICON (SIMETHICONE) 80MG CHEW TAB,7017560,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
MYSOLINE (PRIMIDONE) 50MG TAB,7017565,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
NAPROSYN (NAPROXEN SOD) 500MG TB,7017590,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZNAVANE (THIOTHIXENE) 2MG CAP,7017595,CDM,250,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ZZZNAVANE (THIOTHIXENE) 5MG CAP,7017605,CDM,250,RC,,,Outpatient,,,29,14.5,,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,23.2,80,,,percent of total billed charges,80% of total billed charges ,7.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,7.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,9.05,31.2,,,percent of total billed charges,31.2% of total billed charges,23.2,80,,,percent of total billed charges,80% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,23.2,
NEOMYCIN 500MG TAB,7017615,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
NEURONTIN (GABAPENTIN) 100MG CAP,7017618,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
NEURONTIN (GABAPENTIN) 300MG CAP,7017619,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
NEPHRO-VITE (FA C BIOTIN VI ) CAP,7017625,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
NIACIN 100MG TAB,7017635,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZNIZORAL (KETOCONAZOLE ) 200MG TAB,7017675,CDM,250,RC,,,Outpatient,,,30,15,,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,24,80,,,percent of total billed charges,80% of total billed charges ,7.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,,,percent of total billed charges,31.2% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,
NORVASC (AMLODIPINE) 5MG TAB,7017677,CDM,250,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ZZZTAMOXIFEN 10MG TAB,7017685,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZFERREX 150MG CAP,7017737,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
OCUVITE (ANTIOXIDANT W/LUTEIN)CAPSULE,7017738,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ORAZINC (ZINC SULFATE) 220MG CAP,7017742,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
OS-CAL (CAL CARB 1250MG) 500MG TAB,7017765,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZSLOW MAG (MAGNESIUM CHL) TAB,7017769,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZPANCREAZE (PANCRELIP) 4200 CAP,7017770,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
PAMELOR (NORTRIPTYLINE) 10MG CAP,7017780,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
PAMELOR (NORTRIPTYLINE) 25MG CAP,7017785,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
PAXIL (PAROXETINE) 20MG TAB,7017793,CDM,250,RC,,,Outpatient,,,22.5,11.25,,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,18,
PEPCID (FAMOTIDINE) 20MG TAB,7017804,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
PERIACTIN (CYPROHEPTADINE) 4MG TAB,7017822,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
PHOSLO (CALCIUM ACET) 667MG CAP,7017859,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
PHENERGAN (PROMETHAZINE) 25MG TAB,7017860,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
PLAQUENIL (HYDROXYCHLOROQUINE) 200MG,7017863,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
PLENDIL (FELODIPINE ER) 5MG TAB,7017864,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
PREDNISONE 5MG TAB,7017870,CDM,636,RC,J7512,HCPCS,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
PREDNISONE 10MG TAB,7017875,CDM,636,RC,J7512,HCPCS,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
PREDNISONE 20MG TAB,7017880,CDM,636,RC,J7512,HCPCS,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZPREMARIN (CONJUGATED ESTR) 0.3MG TAB,7017884,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
ZZZPREMARIN (CONJUGATED ESTR) 0.625MG TB,7017890,CDM,250,RC,,,Outpatient,,,23.5,11.75,,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,18.8,80,,,percent of total billed charges,80% of total billed charges ,5.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,7.33,31.2,,,percent of total billed charges,31.2% of total billed charges,18.8,80,,,percent of total billed charges,80% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,18.8,
PROZAC (FLUOXETINE HCL) 10MG TAB,7017899,CDM,250,RC,,,Outpatient,,,22.5,11.25,,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,18,
PROZAC (FLUOXETINE HCL) 20MG CAP,7017900,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
PROBENECID 500MG TAB,7017903,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
PROCARDIA (NIFEDIPINE) 10MG CAP,7017920,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
ZZZPROCARDIA XL (NIFEDIPINE ER) 60MG TAB,7017922,CDM,250,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
PROCARDIA XL (NIFEDIPINE ER) 30MG TAB,7017925,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
PROSCAR (FINASTERIDE) 5MG TAB,7017962,CDM,250,RC,,,Outpatient,,,26,13,,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,20.8,
PROVERA (MEDROXYPROGESTERONE) 2.5MG,7017973,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZPROVERA (MEDROXYPROGESTERONE) 10MG TA,7017975,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZPROPYLTHIOURACIL 50MG TAB,7017980,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZPYRIDIUM (PHENAZOPYRID) 100MG TAB,7017985,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
VITAMIN B-6 (PYRIDOXINE) 100MG TAB,7017987,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
QUESTRAN (CHOLESTYRAMINE) 4GRAM PACKET,7017997,CDM,250,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
REGLAN (METOCLOPRAMIDE) 10MG TAB,7018025,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZRETROVIR (ZIDOVUDINE) 100MG CAP,7018033,CDM,250,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
RISPERDAL (RISPERIDONE) 1MG TAB,7018038,CDM,250,RC,,,Outpatient,,,35,17.5,,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,28,80,,,percent of total billed charges,80% of total billed charges ,8.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,10.92,31.2,,,percent of total billed charges,31.2% of total billed charges,28,80,,,percent of total billed charges,80% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,28,
RIFAMPIN (RIFADIN) 300MG CAP,7018045,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ROBAXIN (METHOCARBAMOL) 500MG TAB,7018049,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ROCALTROL (CALCITROL) 0.25MCG CAP,7018060,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
SENNA LAX (SENNA) 8.6MG TAB,7018085,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
SEPTRA DS (SMZ/TMP 800/160MG) TAB,7018095,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
SINEMET (CARB/LEVOD) 10MG/100MG TAB,7018120,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
SINEMET (CARB/LEVOD) 25MG/100MG TAB,7018121,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
ZZZSINEQUAN (DOXEPIN) 10MG CAP,7018130,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
SINEQUAN (DOXEPIN) 25MG CAP,7018145,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
THEO-DUR (THEOPHYLLINE ER) 200MG TB,7018154,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
THEO-DUR (THEOPHYLLINE ER) 300MG TB,7018156,CDM,250,RC,,,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
CIPROFLOXACIN 200MG/100ML PREMIX IV,7018165,CDM,636,RC,J0744,HCPCS,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
SODIUM BICARBONTE 650MG TAB,7018180,CDM,250,RC,,,Outpatient,,,15,7.5,,4.03,26.86,,,percent of total billed charges,26.86% of total billed charges,11.25,75,,,percent of total billed charges,75% of total billed charges ,11.25,75,,,percent of total billed charges,75% of total billed charges ,3.6,24,,,percent of total billed charges,24% of total billed charges ,11.25,75,,,percent of total billed charges,75% of total billed charges ,11.25,75,,,percent of total billed charges,75% of total billed charges ,12,80,,,percent of total billed charges,80% of total billed charges ,3.64,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.25,75,,,percent of total billed charges,75% of total billed charges ,3.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.03,26.86,,,percent of total billed charges,26.86% of total billed charges,3.6,24,,,percent of total billed charges,24% of total billed charges ,4.68,31.2,,,percent of total billed charges,31.2% of total billed charges,12,80,,,percent of total billed charges,80% of total billed charges,3.6,24,,,percent of total billed charges,24% of total billed charges ,3.6,24,,,percent of total billed charges,24% of total billed charges ,3.6,12,
SOMA (CARISOPRODOL) 350MG TAB,7018190,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ULTRAM (TRAMADOL HCL) 50MG TAB,7018324,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ZESTRIL (LISINOPRIL) 10MG TAB,7018444,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
ZITHROMAX (AZITHROMY) 250MG TAB,7018445,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ZZZZOVIRAX (ACYCLOVIR) 800MGTAB,7018448,CDM,250,RC,,,Outpatient,,,29,14.5,,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,23.2,80,,,percent of total billed charges,80% of total billed charges ,7.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,7.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,9.05,31.2,,,percent of total billed charges,31.2% of total billed charges,23.2,80,,,percent of total billed charges,80% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,23.2,
EPINEPHRINE 1:1000 (1MG/ML) 1ML AMP,7019000,CDM,636,RC,J0171,HCPCS,Outpatient,,,96,48,,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,0.75,76.8,
ACTIVASE (ALTEPLASE) 100MG IV SOL,7019004,CDM,636,RC,J2997,HCPCS,Outpatient,,,42048.5,21024.25,,11294.23,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10091.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33638.8,80,,,percent of total billed charges,80% of total billed charges ,10192.56,24.24,,,percent of total billed charges,24.24% of total billed charges ,21192.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,31536.38,75,,,percent of total billed charges,75% of total billed charges ,10293.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,11294.23,26.86,,,percent of total billed charges,26.86% of total billed charges,10091.64,24,,,percent of total billed charges,24% of total billed charges ,13119.13,31.2,,,percent of total billed charges,31.2% of total billed charges,33638.8,80,,,percent of total billed charges,80% of total billed charges,10091.64,24,,,percent of total billed charges,24% of total billed charges ,10091.64,24,,,percent of total billed charges,24% of total billed charges ,10091.64,33638.8,
ADENOCARD (ADENOSINE) 6MG/2ML INJ,7019009,CDM,636,RC,J0153,HCPCS,Outpatient,,,75,37.5,,0.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60,80,,,percent of total billed charges,80% of total billed charges ,18.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,18.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18,24,,,percent of total billed charges,24% of total billed charges ,23.4,31.2,,,percent of total billed charges,31.2% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,18,24,,,percent of total billed charges,24% of total billed charges ,18,24,,,percent of total billed charges,24% of total billed charges ,0.6,60,
AMIOPHYLLINE 250MG/10ML INJ,7019030,CDM,636,RC,J0280,HCPCS,Outpatient,,,77.5,38.75,,5.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62,80,,,percent of total billed charges,80% of total billed charges ,18.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,18.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.6,24,,,percent of total billed charges,24% of total billed charges ,24.18,31.2,,,percent of total billed charges,31.2% of total billed charges,62,80,,,percent of total billed charges,80% of total billed charges,18.6,24,,,percent of total billed charges,24% of total billed charges ,18.6,24,,,percent of total billed charges,24% of total billed charges ,5.13,62,
ATROPINE SULF 1MG/10ML SYRINGE,7019050,CDM,636,RC,J0461,HCPCS,Outpatient,,,64,32,,0.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,0.08,51.2,
MAG-OX (MAGNESIUM OXIDE) 400MG TAB,7019054,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
VITAMIN K (PHYTONADIONE) 10MG/ML,7019080,CDM,636,RC,J3430,HCPCS,Outpatient,,,249.5,124.75,,2.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,59.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,199.6,80,,,percent of total billed charges,80% of total billed charges ,60.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,125.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,187.13,75,,,percent of total billed charges,75% of total billed charges ,61.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,59.88,24,,,percent of total billed charges,24% of total billed charges ,77.84,31.2,,,percent of total billed charges,31.2% of total billed charges,199.6,80,,,percent of total billed charges,80% of total billed charges,59.88,24,,,percent of total billed charges,24% of total billed charges ,59.88,24,,,percent of total billed charges,24% of total billed charges ,2.9,199.6,
VITAMIN B-12 (CYANOCOB) 1000MCG INJ,7019110,CDM,636,RC,J3420,HCPCS,Outpatient,,,54.5,27.25,,1.44,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,43.6,80,,,percent of total billed charges,80% of total billed charges ,13.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,27.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,13.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.44,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.08,24,,,percent of total billed charges,24% of total billed charges ,17,31.2,,,percent of total billed charges,31.2% of total billed charges,43.6,80,,,percent of total billed charges,80% of total billed charges,13.08,24,,,percent of total billed charges,24% of total billed charges ,13.08,24,,,percent of total billed charges,24% of total billed charges ,1.44,43.6,
BENADRYL (DIPHENHYD) 50MG/ML INJ,7019140,CDM,636,RC,J1200,HCPCS,Outpatient,,,27,13.5,,0.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,0.8,21.6,
BENTYL (DICYCLOMINE HCL) 20MG/2ML INJ,7019160,CDM,636,RC,J0500,HCPCS,Outpatient,,,412.5,206.25,,24.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,99,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,330,80,,,percent of total billed charges,80% of total billed charges ,99.99,24.24,,,percent of total billed charges,24.24% of total billed charges ,207.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,309.38,75,,,percent of total billed charges,75% of total billed charges ,100.98,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,99,24,,,percent of total billed charges,24% of total billed charges ,128.7,31.2,,,percent of total billed charges,31.2% of total billed charges,330,80,,,percent of total billed charges,80% of total billed charges,99,24,,,percent of total billed charges,24% of total billed charges ,99,24,,,percent of total billed charges,24% of total billed charges ,24.97,330,
BRETHINE (TERBUTALINE) 1MG/ML INJ,7019165,CDM,636,RC,J3105,HCPCS,Outpatient,,,37,18.5,,7.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,7.79,29.6,
BREVIBLOC (ESMOLOL HCL) 100MG/10ML IV,7019180,CDM,258,RC,,,Outpatient,,,55.5,27.75,,14.91,26.86,,,percent of total billed charges,26.86% of total billed charges,41.63,75,,,percent of total billed charges,75% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,13.32,24,,,percent of total billed charges,24% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,44.4,80,,,percent of total billed charges,80% of total billed charges ,13.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,27.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,13.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.91,26.86,,,percent of total billed charges,26.86% of total billed charges,13.32,24,,,percent of total billed charges,24% of total billed charges ,17.32,31.2,,,percent of total billed charges,31.2% of total billed charges,44.4,80,,,percent of total billed charges,80% of total billed charges,13.32,24,,,percent of total billed charges,24% of total billed charges ,13.32,24,,,percent of total billed charges,24% of total billed charges ,13.32,44.4,
BUMEX (BUMETANIDE) 1MG/4ML INJECT,7019210,CDM,250,RC,,,Outpatient,,,26,13,,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,20.8,
CALCIUM CHLORIDE 10% INJ 1GM/10ML,7019230,CDM,250,RC,,,Outpatient,,,64,32,,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,51.2,
CALCIUM GLUCONATE 10% INJ 1GM/10ML,7019240,CDM,636,RC,J0612,HCPCS,Outpatient,,,64,32,,0.05,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.05,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,0.05,51.2,
ZZZCIPROFLOXACIN 200MG/20ML VIAL,7019283,CDM,636,RC,J0744,HCPCS,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
CIPROFLOXACIN 400MG/200ML PREMIX IV,7019286,CDM,636,RC,J0744,HCPCS,Outpatient,,,127.5,63.75,,34.25,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,102,80,,,percent of total billed charges,80% of total billed charges ,30.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,64.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,31.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,34.25,26.86,,,percent of total billed charges,26.86% of total billed charges,30.6,24,,,percent of total billed charges,24% of total billed charges ,39.78,31.2,,,percent of total billed charges,31.2% of total billed charges,102,80,,,percent of total billed charges,80% of total billed charges,30.6,24,,,percent of total billed charges,24% of total billed charges ,30.6,24,,,percent of total billed charges,24% of total billed charges ,30.6,102,
ZZZCOGENTIN (BENZTROPINE) 2MG/2ML INJ,7019290,CDM,636,RC,J0515,HCPCS,Outpatient,,,292.5,146.25,,16.44,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,70.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,234,80,,,percent of total billed charges,80% of total billed charges ,70.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,147.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,219.38,75,,,percent of total billed charges,75% of total billed charges ,71.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.44,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,70.2,24,,,percent of total billed charges,24% of total billed charges ,91.26,31.2,,,percent of total billed charges,31.2% of total billed charges,234,80,,,percent of total billed charges,80% of total billed charges,70.2,24,,,percent of total billed charges,24% of total billed charges ,70.2,24,,,percent of total billed charges,24% of total billed charges ,16.44,234,
CORTROSYN (COSYNTROPINE) 0.25MG INJ,7019294,CDM,636,RC,J0834,HCPCS,Outpatient,,,545,272.5,,27.11,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,130.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,436,80,,,percent of total billed charges,80% of total billed charges ,132.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,274.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,408.75,75,,,percent of total billed charges,75% of total billed charges ,133.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.11,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,130.8,24,,,percent of total billed charges,24% of total billed charges ,170.04,31.2,,,percent of total billed charges,31.2% of total billed charges,436,80,,,percent of total billed charges,80% of total billed charges,130.8,24,,,percent of total billed charges,24% of total billed charges ,130.8,24,,,percent of total billed charges,24% of total billed charges ,27.11,436,
COMPAZINE (PROCHLORPER) 10MG/2ML,7019299,CDM,636,RC,J0780,HCPCS,Outpatient,,,117.5,58.75,,3.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,94,80,,,percent of total billed charges,80% of total billed charges ,28.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,59.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,88.13,75,,,percent of total billed charges,75% of total billed charges ,28.76,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.2,24,,,percent of total billed charges,24% of total billed charges ,36.66,31.2,,,percent of total billed charges,31.2% of total billed charges,94,80,,,percent of total billed charges,80% of total billed charges,28.2,24,,,percent of total billed charges,24% of total billed charges ,28.2,24,,,percent of total billed charges,24% of total billed charges ,3.43,94,
ERYTHROMYCIN 500MG INJ,7019305,CDM,636,RC,J1364,HCPCS,Outpatient,,,478,239,,80.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,114.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,382.4,80,,,percent of total billed charges,80% of total billed charges ,115.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,240.91,50.4,,,percent of total billed charges,50.4% of total billed charges ,358.5,75,,,percent of total billed charges,75% of total billed charges ,117.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,80.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,114.72,24,,,percent of total billed charges,24% of total billed charges ,149.14,31.2,,,percent of total billed charges,31.2% of total billed charges,382.4,80,,,percent of total billed charges,80% of total billed charges,114.72,24,,,percent of total billed charges,24% of total billed charges ,114.72,24,,,percent of total billed charges,24% of total billed charges ,80.78,382.4,
DANTRIUM (DANTROLENE SOD) 20MG INJ,7019310,CDM,250,RC,,,Outpatient,,,1923.75,961.88,,516.72,26.86,,,percent of total billed charges,26.86% of total billed charges,1442.81,75,,,percent of total billed charges,75% of total billed charges ,1442.81,75,,,percent of total billed charges,75% of total billed charges ,461.7,24,,,percent of total billed charges,24% of total billed charges ,1442.81,75,,,percent of total billed charges,75% of total billed charges ,1442.81,75,,,percent of total billed charges,75% of total billed charges ,1539,80,,,percent of total billed charges,80% of total billed charges ,466.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,969.57,50.4,,,percent of total billed charges,50.4% of total billed charges ,1442.81,75,,,percent of total billed charges,75% of total billed charges ,470.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,516.72,26.86,,,percent of total billed charges,26.86% of total billed charges,461.7,24,,,percent of total billed charges,24% of total billed charges ,600.21,31.2,,,percent of total billed charges,31.2% of total billed charges,1539,80,,,percent of total billed charges,80% of total billed charges,461.7,24,,,percent of total billed charges,24% of total billed charges ,461.7,24,,,percent of total billed charges,24% of total billed charges ,461.7,1539,
ZZZD.H.E.(DIHYDROERGOTAMINE) 1MG/ML,7019340,CDM,636,RC,J1110,HCPCS,Outpatient,,,663.5,331.75,,42.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,530.8,80,,,percent of total billed charges,80% of total billed charges ,160.83,24.24,,,percent of total billed charges,24.24% of total billed charges ,334.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,497.63,75,,,percent of total billed charges,75% of total billed charges ,162.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,42.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,159.24,24,,,percent of total billed charges,24% of total billed charges ,207.01,31.2,,,percent of total billed charges,31.2% of total billed charges,530.8,80,,,percent of total billed charges,80% of total billed charges,159.24,24,,,percent of total billed charges,24% of total billed charges ,159.24,24,,,percent of total billed charges,24% of total billed charges ,42.34,530.8,
D25 (DEXTROSE 25% ) 10ML SYR,7019350,CDM,636,RC,J7799,HCPCS,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
DECADRON (DEXAMETHASONE) 4MG/ML INJ,7019360,CDM,636,RC,J1100,HCPCS,Outpatient,,,27,13.5,,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,0.12,21.6,
D50W (DEXTROSE 50% WATER) 50ML SYR,7019370,CDM,636,RC,J7120,HCPCS,Outpatient,,,151.5,75.75,,2.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,121.2,80,,,percent of total billed charges,80% of total billed charges ,36.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,76.36,50.4,,,percent of total billed charges,50.4% of total billed charges ,113.63,75,,,percent of total billed charges,75% of total billed charges ,37.09,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,36.36,24,,,percent of total billed charges,24% of total billed charges ,47.27,31.2,,,percent of total billed charges,31.2% of total billed charges,121.2,80,,,percent of total billed charges,80% of total billed charges,36.36,24,,,percent of total billed charges,24% of total billed charges ,36.36,24,,,percent of total billed charges,24% of total billed charges ,2.59,121.2,
DECADRON (DEXAMETHASONE) 10MG/ML INJ,7019380,CDM,636,RC,J1100,HCPCS,Outpatient,,,15.5,7.75,,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,0.12,12.4,
ZZZDEPO-ESTRADIOL (DEPO CYPIONATE) 5MG,7019400,CDM,636,RC,J1000,HCPCS,Outpatient,,,65,32.5,,35.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52,80,,,percent of total billed charges,80% of total billed charges ,15.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.6,24,,,percent of total billed charges,24% of total billed charges ,20.28,31.2,,,percent of total billed charges,31.2% of total billed charges,52,80,,,percent of total billed charges,80% of total billed charges,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,52,
ZZZDEPO-TESTOSTERONE (TEST CYPIO) 100MG,7019410,CDM,250,RC,J1071,HCPCS,Outpatient,,,55.5,27.75,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,41.63,75,,,percent of total billed charges,75% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,13.32,24,,,percent of total billed charges,24% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,44.4,80,,,percent of total billed charges,80% of total billed charges ,13.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,27.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,41.63,75,,,percent of total billed charges,75% of total billed charges ,13.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.32,24,,,percent of total billed charges,24% of total billed charges ,17.32,31.2,,,percent of total billed charges,31.2% of total billed charges,44.4,80,,,percent of total billed charges,80% of total billed charges,13.32,24,,,percent of total billed charges,24% of total billed charges ,13.32,24,,,percent of total billed charges,24% of total billed charges ,0.03,44.4,
DILANTIN (PHENYTOIN) 100MG/2ML INJECT,7019430,CDM,636,RC,J1165,HCPCS,Outpatient,,,15.5,7.75,,0.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,0.63,12.4,
LANOXIN (DIGOXIN) 0.5MG (500MCG)/2ML INJ,7019450,CDM,636,RC,J1160,HCPCS,Outpatient,,,43.5,21.75,,9.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.8,80,,,percent of total billed charges,80% of total billed charges ,10.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.44,24,,,percent of total billed charges,24% of total billed charges ,13.57,31.2,,,percent of total billed charges,31.2% of total billed charges,34.8,80,,,percent of total billed charges,80% of total billed charges,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,9.41,34.8,
LANOXIN (DIGOXIN) 0.125MG TAB,7019460,CDM,250,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
DIPRIVAN (PROPOFOL) 200MG/20ML,7019465,CDM,636,RC,J2704,HCPCS,Outpatient,,,44,22,,11.82,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.2,80,,,percent of total billed charges,80% of total billed charges ,10.67,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,33,75,,,percent of total billed charges,75% of total billed charges ,10.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.82,26.86,,,percent of total billed charges,26.86% of total billed charges,10.56,24,,,percent of total billed charges,24% of total billed charges ,13.73,31.2,,,percent of total billed charges,31.2% of total billed charges,35.2,80,,,percent of total billed charges,80% of total billed charges,10.56,24,,,percent of total billed charges,24% of total billed charges ,10.56,24,,,percent of total billed charges,24% of total billed charges ,10.56,35.2,
DOBUTAMINE 2000MCG/ML (250ML) IV DRIP,7019466,CDM,636,RC,J1250,HCPCS,Outpatient,,,178,89,,9.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,9.85,142.4,
EPINEPHRINE 1:10000 (1MG/10ML) SYR,7019520,CDM,636,RC,J0171,HCPCS,Outpatient,,,130,65,,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,104,80,,,percent of total billed charges,80% of total billed charges ,31.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,65.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,97.5,75,,,percent of total billed charges,75% of total billed charges ,31.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.2,24,,,percent of total billed charges,24% of total billed charges ,40.56,31.2,,,percent of total billed charges,31.2% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,31.2,24,,,percent of total billed charges,24% of total billed charges ,31.2,24,,,percent of total billed charges,24% of total billed charges ,0.75,104,
EPINEPHRINE 1:1000 (1MG/ML) 30ML,7019521,CDM,636,RC,J0171,HCPCS,Outpatient,,,1033,516.5,,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,247.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,826.4,80,,,percent of total billed charges,80% of total billed charges ,250.4,24.24,,,percent of total billed charges,24.24% of total billed charges ,520.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,774.75,75,,,percent of total billed charges,75% of total billed charges ,252.88,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,247.92,24,,,percent of total billed charges,24% of total billed charges ,322.3,31.2,,,percent of total billed charges,31.2% of total billed charges,826.4,80,,,percent of total billed charges,80% of total billed charges,247.92,24,,,percent of total billed charges,24% of total billed charges ,247.92,24,,,percent of total billed charges,24% of total billed charges ,0.75,826.4,
"PROCRIT (EPOETIN ALPH) 10,000 UNIT/ML VL",7019522,CDM,636,RC,J0885,HCPCS,Outpatient,,,1311,655.5,,8.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,314.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1048.8,80,,,percent of total billed charges,80% of total billed charges ,317.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,660.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,983.25,75,,,percent of total billed charges,75% of total billed charges ,320.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,314.64,24,,,percent of total billed charges,24% of total billed charges ,409.03,31.2,,,percent of total billed charges,31.2% of total billed charges,1048.8,80,,,percent of total billed charges,80% of total billed charges,314.64,24,,,percent of total billed charges,24% of total billed charges ,314.64,24,,,percent of total billed charges,24% of total billed charges ,8.89,1048.8,
GENTAMYCIN 40MG/ML 2ML INJ,7019560,CDM,636,RC,J1580,HCPCS,Outpatient,,,31,15.5,,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,2.69,24.8,
GLUCAGON 1MG KIT,7019570,CDM,636,RC,J1610,HCPCS,Outpatient,,,1333,666.5,,188.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,319.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1066.4,80,,,percent of total billed charges,80% of total billed charges ,323.12,24.24,,,percent of total billed charges,24.24% of total billed charges ,671.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,999.75,75,,,percent of total billed charges,75% of total billed charges ,326.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,188.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,319.92,24,,,percent of total billed charges,24% of total billed charges ,415.9,31.2,,,percent of total billed charges,31.2% of total billed charges,1066.4,80,,,percent of total billed charges,80% of total billed charges,319.92,24,,,percent of total billed charges,24% of total billed charges ,319.92,24,,,percent of total billed charges,24% of total billed charges ,188.37,1066.4,
HALDOL (HALOPERIDOL LAC) 5MG/ML INJ,7019580,CDM,636,RC,J1630,HCPCS,Outpatient,,,45.5,22.75,,1.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,36.4,80,,,percent of total billed charges,80% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,1.42,36.4,
HEPARIN (PORCINE) 1000 UNIT/ML INJ,7019610,CDM,636,RC,J1644,HCPCS,Outpatient,,,16.5,8.25,,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,0.27,13.2,
HEPARIN (PORCINE) 5000 UNIT/ML INJ,7019660,CDM,636,RC,J1644,HCPCS,Outpatient,,,34,17,,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,0.27,27.2,
"ZZZHEPARIN (PORCINE) 10,000 UNIT/ML INJ",7019670,CDM,636,RC,J1644,HCPCS,Outpatient,,,37,18.5,,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,0.27,29.6,
SOLU-CORTEF (HYDROCORTISONE) 100MG VI,7019680,CDM,636,RC,J1720,HCPCS,Outpatient,,,121.41,60.71,,17.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.14,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,97.13,80,,,percent of total billed charges,80% of total billed charges ,29.43,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.19,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.06,75,,,percent of total billed charges,75% of total billed charges ,29.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.14,24,,,percent of total billed charges,24% of total billed charges ,37.88,31.2,,,percent of total billed charges,31.2% of total billed charges,97.13,80,,,percent of total billed charges,80% of total billed charges,29.14,24,,,percent of total billed charges,24% of total billed charges ,29.14,24,,,percent of total billed charges,24% of total billed charges ,17.85,97.13,
ZZZVISTARIL (HYDROXYZ HCL) 50MG/ML IM,7019700,CDM,636,RC,J3410,HCPCS,Outpatient,,,50.5,25.25,,9.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40.4,80,,,percent of total billed charges,80% of total billed charges ,12.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,12.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.12,24,,,percent of total billed charges,24% of total billed charges ,15.76,31.2,,,percent of total billed charges,31.2% of total billed charges,40.4,80,,,percent of total billed charges,80% of total billed charges,12.12,24,,,percent of total billed charges,24% of total billed charges ,12.12,24,,,percent of total billed charges,24% of total billed charges ,9.91,40.4,
IMITREX (SUMATRIPTAN) 6MG/0.5ML INJ,7019742,CDM,636,RC,J3030,HCPCS,Outpatient,,,305,152.5,,62.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,73.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,244,80,,,percent of total billed charges,80% of total billed charges ,73.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,153.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,228.75,75,,,percent of total billed charges,75% of total billed charges ,74.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,62.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,73.2,24,,,percent of total billed charges,24% of total billed charges ,95.16,31.2,,,percent of total billed charges,31.2% of total billed charges,244,80,,,percent of total billed charges,80% of total billed charges,73.2,24,,,percent of total billed charges,24% of total billed charges ,73.2,24,,,percent of total billed charges,24% of total billed charges ,62.75,244,
DROPERIDOL 5MG/2ML AMP INJ,7019780,CDM,636,RC,J1790,HCPCS,Outpatient,,,61,30.5,,8.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.8,80,,,percent of total billed charges,80% of total billed charges ,14.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,30.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,14.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.64,24,,,percent of total billed charges,24% of total billed charges ,19.03,31.2,,,percent of total billed charges,31.2% of total billed charges,48.8,80,,,percent of total billed charges,80% of total billed charges,14.64,24,,,percent of total billed charges,24% of total billed charges ,14.64,24,,,percent of total billed charges,24% of total billed charges ,8.95,48.8,
KENALOG (TRIAMCINOLONE) 40MG/ML INJ,7019810,CDM,636,RC,J3301,HCPCS,Outpatient,,,66,33,,0.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.8,80,,,percent of total billed charges,80% of total billed charges ,16,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,16.16,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.84,24,,,percent of total billed charges,24% of total billed charges ,20.59,31.2,,,percent of total billed charges,31.2% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,0.95,52.8,
ZZZLEVSIN (HYOSCYAMINE) 0.5MG/ML INJECT,7019820,CDM,636,RC,J1980,HCPCS,Outpatient,,,203,101.5,,35.46,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,162.4,80,,,percent of total billed charges,80% of total billed charges ,49.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,102.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,152.25,75,,,percent of total billed charges,75% of total billed charges ,49.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.46,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,48.72,24,,,percent of total billed charges,24% of total billed charges ,63.34,31.2,,,percent of total billed charges,31.2% of total billed charges,162.4,80,,,percent of total billed charges,80% of total billed charges,48.72,24,,,percent of total billed charges,24% of total billed charges ,48.72,24,,,percent of total billed charges,24% of total billed charges ,35.46,162.4,
LEVOPHED (NOREPINEPHRINE) 4MG/4ML INJ,7019830,CDM,250,RC,,,Outpatient,,,132.75,66.38,,35.66,26.86,,,percent of total billed charges,26.86% of total billed charges,99.56,75,,,percent of total billed charges,75% of total billed charges ,99.56,75,,,percent of total billed charges,75% of total billed charges ,31.86,24,,,percent of total billed charges,24% of total billed charges ,99.56,75,,,percent of total billed charges,75% of total billed charges ,99.56,75,,,percent of total billed charges,75% of total billed charges ,106.2,80,,,percent of total billed charges,80% of total billed charges ,32.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,66.91,50.4,,,percent of total billed charges,50.4% of total billed charges ,99.56,75,,,percent of total billed charges,75% of total billed charges ,32.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.66,26.86,,,percent of total billed charges,26.86% of total billed charges,31.86,24,,,percent of total billed charges,24% of total billed charges ,41.42,31.2,,,percent of total billed charges,31.2% of total billed charges,106.2,80,,,percent of total billed charges,80% of total billed charges,31.86,24,,,percent of total billed charges,24% of total billed charges ,31.86,24,,,percent of total billed charges,24% of total billed charges ,31.86,106.2,
LOPRESSOR (METOPROLOL) 5MG/5ML AMP,7019834,CDM,636,RC,,,Outpatient,,,23.5,11.75,,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.8,80,,,percent of total billed charges,80% of total billed charges ,5.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,7.33,31.2,,,percent of total billed charges,31.2% of total billed charges,18.8,80,,,percent of total billed charges,80% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,18.8,
ZZZMAGNESIUM SUL 1GM/2ML INJ (IM ONLY),7019850,CDM,636,RC,J3475,HCPCS,Outpatient,,,21.5,10.75,,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,0.69,17.2,
LASIX (FUROSEMIDE) 20MG/2ML VIAL,7019877,CDM,636,RC,J1940,HCPCS,Outpatient,,,22.5,11.25,,0.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,0.57,18,
LASIX (FUROSEMIDE) 40MG/4ML VIAL,7019888,CDM,636,RC,J1940,HCPCS,Outpatient,,,83.5,41.75,,0.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,0.57,66.8,
LASIX (FUROSEMIDE) 100MG/10ML,7019892,CDM,636,RC,J1940,HCPCS,Outpatient,,,37,18.5,,0.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,0.57,29.6,
NORFLEX (ORPHENADRINE) 60MG/2ML INJ,7019900,CDM,636,RC,J2360,HCPCS,Outpatient,,,101,50.5,,9.71,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.71,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,9.71,80.8,
ROMAZICON (FLUMAZENIL)0.1MG/ML (5ML),7019916,CDM,250,RC,,,Outpatient,,,50.5,25.25,,13.56,26.86,,,percent of total billed charges,26.86% of total billed charges,37.88,75,,,percent of total billed charges,75% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,12.12,24,,,percent of total billed charges,24% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,40.4,80,,,percent of total billed charges,80% of total billed charges ,12.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,12.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.56,26.86,,,percent of total billed charges,26.86% of total billed charges,12.12,24,,,percent of total billed charges,24% of total billed charges ,15.76,31.2,,,percent of total billed charges,31.2% of total billed charges,40.4,80,,,percent of total billed charges,80% of total billed charges,12.12,24,,,percent of total billed charges,24% of total billed charges ,12.12,24,,,percent of total billed charges,24% of total billed charges ,12.12,40.4,
MEGACE (MEGESTEROL) 400MG/10ML BOT,7019918,CDM,250,RC,,,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
ZZZMETHERGINE (METHYLERGONOVINE) 0.2MG,7019920,CDM,636,RC,J2210,HCPCS,Outpatient,,,124.5,62.25,,19.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,99.6,80,,,percent of total billed charges,80% of total billed charges ,30.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,62.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,93.38,75,,,percent of total billed charges,75% of total billed charges ,30.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.88,24,,,percent of total billed charges,24% of total billed charges ,38.84,31.2,,,percent of total billed charges,31.2% of total billed charges,99.6,80,,,percent of total billed charges,80% of total billed charges,29.88,24,,,percent of total billed charges,24% of total billed charges ,29.88,24,,,percent of total billed charges,24% of total billed charges ,19.6,99.6,
MVI 12 (MULTIVITAMIN) 10ML INJ,7019940,CDM,250,RC,,,Outpatient,,,1240,620,,333.06,26.86,,,percent of total billed charges,26.86% of total billed charges,930,75,,,percent of total billed charges,75% of total billed charges ,930,75,,,percent of total billed charges,75% of total billed charges ,297.6,24,,,percent of total billed charges,24% of total billed charges ,930,75,,,percent of total billed charges,75% of total billed charges ,930,75,,,percent of total billed charges,75% of total billed charges ,992,80,,,percent of total billed charges,80% of total billed charges ,300.58,24.24,,,percent of total billed charges,24.24% of total billed charges ,624.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,930,75,,,percent of total billed charges,75% of total billed charges ,303.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,333.06,26.86,,,percent of total billed charges,26.86% of total billed charges,297.6,24,,,percent of total billed charges,24% of total billed charges ,386.88,31.2,,,percent of total billed charges,31.2% of total billed charges,992,80,,,percent of total billed charges,80% of total billed charges,297.6,24,,,percent of total billed charges,24% of total billed charges ,297.6,24,,,percent of total billed charges,24% of total billed charges ,297.6,992,
NARCAN (NALOXONE) 0.4MG/ML VIAL,7019960,CDM,636,RC,J2310,HCPCS,Outpatient,,,115.5,57.75,,7.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,92.4,80,,,percent of total billed charges,80% of total billed charges ,28,24.24,,,percent of total billed charges,24.24% of total billed charges ,58.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,86.63,75,,,percent of total billed charges,75% of total billed charges ,28.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.72,24,,,percent of total billed charges,24% of total billed charges ,36.04,31.2,,,percent of total billed charges,31.2% of total billed charges,92.4,80,,,percent of total billed charges,80% of total billed charges,27.72,24,,,percent of total billed charges,24% of total billed charges ,27.72,24,,,percent of total billed charges,24% of total billed charges ,7.29,92.4,
NARCAN (NALOXONE) 1MG/ML 2ML SYR,7019970,CDM,636,RC,J2310,HCPCS,Outpatient,,,201,100.5,,7.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,160.8,80,,,percent of total billed charges,80% of total billed charges ,48.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,101.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,150.75,75,,,percent of total billed charges,75% of total billed charges ,49.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,48.24,24,,,percent of total billed charges,24% of total billed charges ,62.71,31.2,,,percent of total billed charges,31.2% of total billed charges,160.8,80,,,percent of total billed charges,80% of total billed charges,48.24,24,,,percent of total billed charges,24% of total billed charges ,48.24,24,,,percent of total billed charges,24% of total billed charges ,7.29,160.8,
NITROGLYCERIN 25MG/5% DEX 250ML IV,7019990,CDM,250,RC,,,Outpatient,,,112.5,56.25,,30.22,26.86,,,percent of total billed charges,26.86% of total billed charges,84.38,75,,,percent of total billed charges,75% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,27,24,,,percent of total billed charges,24% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,90,80,,,percent of total billed charges,80% of total billed charges ,27.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,56.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,84.38,75,,,percent of total billed charges,75% of total billed charges ,27.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.22,26.86,,,percent of total billed charges,26.86% of total billed charges,27,24,,,percent of total billed charges,24% of total billed charges ,35.1,31.2,,,percent of total billed charges,31.2% of total billed charges,90,80,,,percent of total billed charges,80% of total billed charges,27,24,,,percent of total billed charges,24% of total billed charges ,27,24,,,percent of total billed charges,24% of total billed charges ,27,90,
NEO-SYNEPHRINE (PHENYLEPH) 10MG INJ,7020010,CDM,636,RC,J2371,HCPCS,Outpatient,,,34,17,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
LABETALOL 5MG/ML 20ML INJ,7020014,CDM,636,RC,J1920,HCPCS,Outpatient,,,52.5,26.25,,14.1,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42,80,,,percent of total billed charges,80% of total billed charges ,12.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.46,50.4,,,percent of total billed charges,50.4% of total billed charges ,39.38,75,,,percent of total billed charges,75% of total billed charges ,12.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.1,26.86,,,percent of total billed charges,26.86% of total billed charges,12.6,24,,,percent of total billed charges,24% of total billed charges ,16.38,31.2,,,percent of total billed charges,31.2% of total billed charges,42,80,,,percent of total billed charges,80% of total billed charges,12.6,24,,,percent of total billed charges,24% of total billed charges ,12.6,24,,,percent of total billed charges,24% of total billed charges ,12.6,42,
NITROPRESS (NITROPRUSSIDE) 50MG/2ML,7020016,CDM,250,RC,,,Outpatient,,,125,62.5,,33.58,26.86,,,percent of total billed charges,26.86% of total billed charges,93.75,75,,,percent of total billed charges,75% of total billed charges ,93.75,75,,,percent of total billed charges,75% of total billed charges ,30,24,,,percent of total billed charges,24% of total billed charges ,93.75,75,,,percent of total billed charges,75% of total billed charges ,93.75,75,,,percent of total billed charges,75% of total billed charges ,100,80,,,percent of total billed charges,80% of total billed charges ,30.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,63,50.4,,,percent of total billed charges,50.4% of total billed charges ,93.75,75,,,percent of total billed charges,75% of total billed charges ,30.6,24.48,,,percent of total billed charges,24.48% of total billed charges ,33.58,26.86,,,percent of total billed charges,26.86% of total billed charges,30,24,,,percent of total billed charges,24% of total billed charges ,39,31.2,,,percent of total billed charges,31.2% of total billed charges,100,80,,,percent of total billed charges,80% of total billed charges,30,24,,,percent of total billed charges,24% of total billed charges ,30,24,,,percent of total billed charges,24% of total billed charges ,30,100,
VITAMIN K (PHYTONADIONE) 1MG/0.5ML,7020040,CDM,636,RC,J3430,HCPCS,Outpatient,,,145,72.5,,2.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,116,80,,,percent of total billed charges,80% of total billed charges ,35.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,73.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,108.75,75,,,percent of total billed charges,75% of total billed charges ,35.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.8,24,,,percent of total billed charges,24% of total billed charges ,45.24,31.2,,,percent of total billed charges,31.2% of total billed charges,116,80,,,percent of total billed charges,80% of total billed charges,34.8,24,,,percent of total billed charges,24% of total billed charges ,34.8,24,,,percent of total billed charges,24% of total billed charges ,2.9,116,
PITOCIN (OXYTOCIN) 10 UNIT/ML,7020050,CDM,636,RC,J2590,HCPCS,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
VASOPRESSIN 20 UNIT/ML VIAL,7020060,CDM,250,RC,,,Outpatient,,,894,447,,240.13,26.86,,,percent of total billed charges,26.86% of total billed charges,670.5,75,,,percent of total billed charges,75% of total billed charges ,670.5,75,,,percent of total billed charges,75% of total billed charges ,214.56,24,,,percent of total billed charges,24% of total billed charges ,670.5,75,,,percent of total billed charges,75% of total billed charges ,670.5,75,,,percent of total billed charges,75% of total billed charges ,715.2,80,,,percent of total billed charges,80% of total billed charges ,216.71,24.24,,,percent of total billed charges,24.24% of total billed charges ,450.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,670.5,75,,,percent of total billed charges,75% of total billed charges ,218.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,240.13,26.86,,,percent of total billed charges,26.86% of total billed charges,214.56,24,,,percent of total billed charges,24% of total billed charges ,278.93,31.2,,,percent of total billed charges,31.2% of total billed charges,715.2,80,,,percent of total billed charges,80% of total billed charges,214.56,24,,,percent of total billed charges,24% of total billed charges ,214.56,24,,,percent of total billed charges,24% of total billed charges ,214.56,715.2,
POTASSIUM CL 40MEQ/20ML INJ,7020075,CDM,636,RC,J3480,HCPCS,Outpatient,,,38,19,,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,0.12,30.4,
POTASSIUM PHOSPHATE 45MM/ML INJ (15ML),7020084,CDM,250,RC,,,Outpatient,,,96,48,,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,76.8,
PHENERGAN (PROMETHAZINE)25MG/ML INJ,7020090,CDM,636,RC,J2550,HCPCS,Outpatient,,,18.5,9.25,,3.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,3.59,14.8,
REGLAN (METOCLOPRAMIDE) 10MG/2ML INJ,7020130,CDM,636,RC,J2765,HCPCS,Outpatient,,,18.5,9.25,,1.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,1.09,14.8,
NEOSTIGMINE 1MG/ML 10ML INJ,7020140,CDM,636,RC,J2710,HCPCS,Outpatient,,,249.5,124.75,,0.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,59.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,199.6,80,,,percent of total billed charges,80% of total billed charges ,60.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,125.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,187.13,75,,,percent of total billed charges,75% of total billed charges ,61.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,59.88,24,,,percent of total billed charges,24% of total billed charges ,77.84,31.2,,,percent of total billed charges,31.2% of total billed charges,199.6,80,,,percent of total billed charges,80% of total billed charges,59.88,24,,,percent of total billed charges,24% of total billed charges ,59.88,24,,,percent of total billed charges,24% of total billed charges ,0.8,199.6,
RABIES (IMMUNE GLOB) 150U/ML (2ML,7020154,CDM,636,RC,90376,HCPCS,Outpatient,,,3490.5,1745.25,,937.55,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,837.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2792.4,80,,,percent of total billed charges,80% of total billed charges ,846.1,24.24,,,percent of total billed charges,24.24% of total billed charges ,1759.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,2617.88,75,,,percent of total billed charges,75% of total billed charges ,854.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,937.55,26.86,,,percent of total billed charges,26.86% of total billed charges,837.72,24,,,percent of total billed charges,24% of total billed charges ,1089.04,31.2,,,percent of total billed charges,31.2% of total billed charges,2792.4,80,,,percent of total billed charges,80% of total billed charges,837.72,24,,,percent of total billed charges,24% of total billed charges ,837.72,24,,,percent of total billed charges,24% of total billed charges ,837.72,2792.4,
SODIUM BICARB 4.2% (2.5MEQ/5ML),7020190,CDM,250,RC,,,Outpatient,,,56.5,28.25,,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
SOLU-CORTEF (HYDROCORTISONE) 250MG VI,7020224,CDM,636,RC,J1720,HCPCS,Outpatient,,,192.45,96.23,,17.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.19,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,153.96,80,,,percent of total billed charges,80% of total billed charges ,46.65,24.24,,,percent of total billed charges,24.24% of total billed charges ,96.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,144.34,75,,,percent of total billed charges,75% of total billed charges ,47.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,46.19,24,,,percent of total billed charges,24% of total billed charges ,60.04,31.2,,,percent of total billed charges,31.2% of total billed charges,153.96,80,,,percent of total billed charges,80% of total billed charges,46.19,24,,,percent of total billed charges,24% of total billed charges ,46.19,24,,,percent of total billed charges,24% of total billed charges ,17.85,153.96,
SODIUM BICARB 8.4% 50ML,7020230,CDM,250,RC,,,Outpatient,,,106,53,,28.47,26.86,,,percent of total billed charges,26.86% of total billed charges,79.5,75,,,percent of total billed charges,75% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,25.44,24,,,percent of total billed charges,24% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,84.8,80,,,percent of total billed charges,80% of total billed charges ,25.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,53.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,25.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.47,26.86,,,percent of total billed charges,26.86% of total billed charges,25.44,24,,,percent of total billed charges,24% of total billed charges ,33.07,31.2,,,percent of total billed charges,31.2% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,25.44,24,,,percent of total billed charges,24% of total billed charges ,25.44,24,,,percent of total billed charges,24% of total billed charges ,25.44,84.8,
SOLU-MEDROL (METHYLPRED) 125MG/2ML,7020250,CDM,636,RC,J2919,HCPCS,Outpatient,,,68,34,,18.26,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.4,80,,,percent of total billed charges,80% of total billed charges ,16.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,16.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.26,26.86,,,percent of total billed charges,26.86% of total billed charges,16.32,24,,,percent of total billed charges,24% of total billed charges ,21.22,31.2,,,percent of total billed charges,31.2% of total billed charges,54.4,80,,,percent of total billed charges,80% of total billed charges,16.32,24,,,percent of total billed charges,24% of total billed charges ,16.32,24,,,percent of total billed charges,24% of total billed charges ,16.32,54.4,
SOLU-MEDROL (METHYLPRED) 40MG/ML VL,7020260,CDM,636,RC,J2919,HCPCS,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
ENEMA FLEETS (PHOSM-B PHOSDI-BA)  133ML,7020312,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
VITAMIN D3(CHOLECALCIFEROL) 1000MCG,7020390,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
THORAZINE(CHLORPROMAZINE) 25MG/ML INJ,7020400,CDM,636,RC,J3230,HCPCS,Outpatient,,,172,86,,29.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,41.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,137.6,80,,,percent of total billed charges,80% of total billed charges ,41.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,86.69,50.4,,,percent of total billed charges,50.4% of total billed charges ,129,75,,,percent of total billed charges,75% of total billed charges ,42.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,41.28,24,,,percent of total billed charges,24% of total billed charges ,53.66,31.2,,,percent of total billed charges,31.2% of total billed charges,137.6,80,,,percent of total billed charges,80% of total billed charges,41.28,24,,,percent of total billed charges,24% of total billed charges ,41.28,24,,,percent of total billed charges,24% of total billed charges ,29.79,137.6,
TORADOL (KETOROLAC) 30MG/ML INJ,7020443,CDM,636,RC,J1885,HCPCS,Outpatient,,,46,23,,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.8,80,,,percent of total billed charges,80% of total billed charges ,11.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.5,75,,,percent of total billed charges,75% of total billed charges ,11.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.04,24,,,percent of total billed charges,24% of total billed charges ,14.35,31.2,,,percent of total billed charges,31.2% of total billed charges,36.8,80,,,percent of total billed charges,80% of total billed charges,11.04,24,,,percent of total billed charges,24% of total billed charges ,11.04,24,,,percent of total billed charges,24% of total billed charges ,0.49,36.8,
TORADOL (KETOROLAC) 60MG/2ML INJ,7020444,CDM,636,RC,J1885,HCPCS,Outpatient,,,50.73,25.37,,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.18,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40.58,80,,,percent of total billed charges,80% of total billed charges ,12.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.57,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.05,75,,,percent of total billed charges,75% of total billed charges ,12.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.18,24,,,percent of total billed charges,24% of total billed charges ,15.83,31.2,,,percent of total billed charges,31.2% of total billed charges,40.58,80,,,percent of total billed charges,80% of total billed charges,12.18,24,,,percent of total billed charges,24% of total billed charges ,12.18,24,,,percent of total billed charges,24% of total billed charges ,0.49,40.58,
UNASYN (AMP/SULB) 1.5GM INJ,7020470,CDM,636,RC,J0295,HCPCS,Outpatient,,,56.5,28.25,,1.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,1.77,45.2,
VANCOMYCIN 500MG VIAL,7020520,CDM,636,RC,J3370,HCPCS,Outpatient,,,58,29,,2.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.4,80,,,percent of total billed charges,80% of total billed charges ,14.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.5,75,,,percent of total billed charges,75% of total billed charges ,14.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.92,24,,,percent of total billed charges,24% of total billed charges ,18.1,31.2,,,percent of total billed charges,31.2% of total billed charges,46.4,80,,,percent of total billed charges,80% of total billed charges,13.92,24,,,percent of total billed charges,24% of total billed charges ,13.92,24,,,percent of total billed charges,24% of total billed charges ,2.31,46.4,
VANCOMYCIN 1GM INJ,7020521,CDM,636,RC,J3370,HCPCS,Outpatient,,,104,52,,2.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,83.2,80,,,percent of total billed charges,80% of total billed charges ,25.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,25.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.96,24,,,percent of total billed charges,24% of total billed charges ,32.45,31.2,,,percent of total billed charges,31.2% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,2.31,83.2,
VASOTEC ENALAPRILAT) 1.25MG/ML INJ,7020523,CDM,250,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
VERAPAMIL 2.5MG/ML(2ML),7020526,CDM,250,RC,,,Outpatient,,,182.5,91.25,,49.02,26.86,,,percent of total billed charges,26.86% of total billed charges,136.88,75,,,percent of total billed charges,75% of total billed charges ,136.88,75,,,percent of total billed charges,75% of total billed charges ,43.8,24,,,percent of total billed charges,24% of total billed charges ,136.88,75,,,percent of total billed charges,75% of total billed charges ,136.88,75,,,percent of total billed charges,75% of total billed charges ,146,80,,,percent of total billed charges,80% of total billed charges ,44.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,91.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,136.88,75,,,percent of total billed charges,75% of total billed charges ,44.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,49.02,26.86,,,percent of total billed charges,26.86% of total billed charges,43.8,24,,,percent of total billed charges,24% of total billed charges ,56.94,31.2,,,percent of total billed charges,31.2% of total billed charges,146,80,,,percent of total billed charges,80% of total billed charges,43.8,24,,,percent of total billed charges,24% of total billed charges ,43.8,24,,,percent of total billed charges,24% of total billed charges ,43.8,146,
"LIDOCAINE-EPI 1% 1:100,000 INJ 20ML",7020544,CDM,250,RC,,,Outpatient,,,35,17.5,,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,28,80,,,percent of total billed charges,80% of total billed charges ,8.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,10.92,31.2,,,percent of total billed charges,31.2% of total billed charges,28,80,,,percent of total billed charges,80% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,28,
LIDOCAINE 0.4% IN D5W SOLN 500ML IV,7020612,CDM,636,RC,J2001,HCPCS,Outpatient,,,48.5,24.25,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.8,80,,,percent of total billed charges,80% of total billed charges ,11.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.64,24,,,percent of total billed charges,24% of total billed charges ,15.13,31.2,,,percent of total billed charges,31.2% of total billed charges,38.8,80,,,percent of total billed charges,80% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,0.03,38.8,
ZOFRAN (ONDANSETRON) 4MG/2ML VIAL,7020646,CDM,636,RC,J2405,HCPCS,Outpatient,,,27,13.5,,0.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.48,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,0.1,21.6,
ZZZSPRAY AND STRETCH SPRAY 3.5OZ,7021059,CDM,250,RC,,,Outpatient,,,117.5,58.75,,31.56,26.86,,,percent of total billed charges,26.86% of total billed charges,88.13,75,,,percent of total billed charges,75% of total billed charges ,88.13,75,,,percent of total billed charges,75% of total billed charges ,28.2,24,,,percent of total billed charges,24% of total billed charges ,88.13,75,,,percent of total billed charges,75% of total billed charges ,88.13,75,,,percent of total billed charges,75% of total billed charges ,94,80,,,percent of total billed charges,80% of total billed charges ,28.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,59.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,88.13,75,,,percent of total billed charges,75% of total billed charges ,28.76,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.56,26.86,,,percent of total billed charges,26.86% of total billed charges,28.2,24,,,percent of total billed charges,24% of total billed charges ,36.66,31.2,,,percent of total billed charges,31.2% of total billed charges,94,80,,,percent of total billed charges,80% of total billed charges,28.2,24,,,percent of total billed charges,24% of total billed charges ,28.2,24,,,percent of total billed charges,24% of total billed charges ,28.2,94,
VALIUM (DIAZEPAM) 5MG/ML 2ML SYRINGE,7023100,CDM,636,RC,J3360,HCPCS,Outpatient,,,155.5,77.75,,5.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,37.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,124.4,80,,,percent of total billed charges,80% of total billed charges ,37.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,78.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,116.63,75,,,percent of total billed charges,75% of total billed charges ,38.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,37.32,24,,,percent of total billed charges,24% of total billed charges ,48.52,31.2,,,percent of total billed charges,31.2% of total billed charges,124.4,80,,,percent of total billed charges,80% of total billed charges,37.32,24,,,percent of total billed charges,24% of total billed charges ,37.32,24,,,percent of total billed charges,24% of total billed charges ,5.47,124.4,
PHENOBARBITAL 130MG/ML INJ,7023140,CDM,636,RC,J2560,HCPCS,Outpatient,,,368.5,184.25,,31.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,88.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,294.8,80,,,percent of total billed charges,80% of total billed charges ,89.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,185.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,276.38,75,,,percent of total billed charges,75% of total billed charges ,90.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,88.44,24,,,percent of total billed charges,24% of total billed charges ,114.97,31.2,,,percent of total billed charges,31.2% of total billed charges,294.8,80,,,percent of total billed charges,80% of total billed charges,88.44,24,,,percent of total billed charges,24% of total billed charges ,88.44,24,,,percent of total billed charges,24% of total billed charges ,31.43,294.8,
FIORINAL W/COD (BUT/ASP/CAF/COD) CAP,7023194,CDM,250,RC,,,Outpatient,,,23.5,11.75,,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,18.8,80,,,percent of total billed charges,80% of total billed charges ,5.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,7.33,31.2,,,percent of total billed charges,31.2% of total billed charges,18.8,80,,,percent of total billed charges,80% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,18.8,
PHENOBARBITAL 20MG/5ML ELIXIR,7023255,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
LIBRIUM (CHLORDIAZEPOXIDE) 5MG CAP,7023320,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
LIBRIUM (CHLORDIAZEPOXIDE) 25MG CP,7023330,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ATIVAN (LORAZEPAM) 1MG TAB,7023350,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ZZZTALWIN NX (PENTAZOCIN-ACET) TAB,7023380,CDM,250,RC,,,Outpatient,,,26,13,,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,20.8,
VALIUM (DIAZEPAM) 5MG TAB,7023400,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
LOMOTIL (DIPHENOX/ATR 2.5/0.025) TAB,7023420,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
VALIUM (DIAZEPAM) 2MG TAB,7023460,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
BUPRENEX (BUPRENORPHINE) 0.3MG INJ,7023500,CDM,636,RC,J0592,HCPCS,Outpatient,,,99,49.5,,26.59,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,79.2,80,,,percent of total billed charges,80% of total billed charges ,24,24.24,,,percent of total billed charges,24.24% of total billed charges ,49.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,74.25,75,,,percent of total billed charges,75% of total billed charges ,24.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.59,26.86,,,percent of total billed charges,26.86% of total billed charges,23.76,24,,,percent of total billed charges,24% of total billed charges ,30.89,31.2,,,percent of total billed charges,31.2% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,23.76,24,,,percent of total billed charges,24% of total billed charges ,23.76,24,,,percent of total billed charges,24% of total billed charges ,23.76,79.2,
FIORICET (BUT/APAP/CAFF) TAB,7023570,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
RESTORIL (TEMAZEPAM) 15MG CAP,7023600,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ZZZRESTORIL (TEMAZEPAM) 30MG CAP,7023610,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
RITALIN (METHYLPHENIDATE) 5MG TAB,7023650,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
PHENOBARBITAL 32.4MG TAB,7023720,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
TYLENOL COD (ACETAMIN) 300-30MG TAB,7023780,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ZOLOFT (SERTALINE) 50MG TAB,7023822,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
MYLICON (SIMETHICONE)20MG/0.3ML DPS,7023890,CDM,250,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
FENTANYL CITRATE 100MCG/2ML  AMP,7023910,CDM,636,RC,J3010,HCPCS,Outpatient,,,21.5,10.75,,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,0.97,17.2,
ZZZDILAUDID (HYDROMORPHONE) 4MG/ML AMP,7023940,CDM,636,RC,J1170,HCPCS,Outpatient,,,12.5,6.25,,4.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10,80,,,percent of total billed charges,80% of total billed charges ,3.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,9.38,75,,,percent of total billed charges,75% of total billed charges ,3.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3,24,,,percent of total billed charges,24% of total billed charges ,3.9,31.2,,,percent of total billed charges,31.2% of total billed charges,10,80,,,percent of total billed charges,80% of total billed charges,3,24,,,percent of total billed charges,24% of total billed charges ,3,24,,,percent of total billed charges,24% of total billed charges ,3,10,
MORPHINE SULFATE 10MG/ML (IV ONLY),7023960,CDM,636,RC,J2270,HCPCS,Outpatient,,,16.5,8.25,,4.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
MS CONTIN (MORPHINE ER) 15MG TAB,7024029,CDM,250,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
MS CONTIN (MORPHINE ER) 30MG TAB,7024030,CDM,250,RC,,,Outpatient,,,17.5,8.75,,4.7,26.86,,,percent of total billed charges,26.86% of total billed charges,13.13,75,,,percent of total billed charges,75% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,4.2,24,,,percent of total billed charges,24% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,14,80,,,percent of total billed charges,80% of total billed charges ,4.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,4.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.7,26.86,,,percent of total billed charges,26.86% of total billed charges,4.2,24,,,percent of total billed charges,24% of total billed charges ,5.46,31.2,,,percent of total billed charges,31.2% of total billed charges,14,80,,,percent of total billed charges,80% of total billed charges,4.2,24,,,percent of total billed charges,24% of total billed charges ,4.2,24,,,percent of total billed charges,24% of total billed charges ,4.2,14,
TYLENOL COD (ACETAMIN) 120-12MG ELI,7024050,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
ZZZDURAGESIC (FENTANYL) 100MCG/HR PTCH,7024055,CDM,250,RC,,,Outpatient,,,268,134,,71.98,26.86,,,percent of total billed charges,26.86% of total billed charges,201,75,,,percent of total billed charges,75% of total billed charges ,201,75,,,percent of total billed charges,75% of total billed charges ,64.32,24,,,percent of total billed charges,24% of total billed charges ,201,75,,,percent of total billed charges,75% of total billed charges ,201,75,,,percent of total billed charges,75% of total billed charges ,214.4,80,,,percent of total billed charges,80% of total billed charges ,64.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,135.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,201,75,,,percent of total billed charges,75% of total billed charges ,65.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,71.98,26.86,,,percent of total billed charges,26.86% of total billed charges,64.32,24,,,percent of total billed charges,24% of total billed charges ,83.62,31.2,,,percent of total billed charges,31.2% of total billed charges,214.4,80,,,percent of total billed charges,80% of total billed charges,64.32,24,,,percent of total billed charges,24% of total billed charges ,64.32,24,,,percent of total billed charges,24% of total billed charges ,64.32,214.4,
PREPARATION H (HEMMORHOIDAL) OINT,7024170,CDM,250,RC,,,Outpatient,,,23.5,11.75,,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,18.8,80,,,percent of total billed charges,80% of total billed charges ,5.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,7.33,31.2,,,percent of total billed charges,31.2% of total billed charges,18.8,80,,,percent of total billed charges,80% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,18.8,
SUDAFED (PSEUDOEPHEDRINE) 30MG TAB,7027040,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
SURFAK (DOCUSATE CAL) 240MG CAP,7027063,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
DIFLUCAN (FLUCONAZOLE) 100MG TAB,7027077,CDM,250,RC,,,Outpatient,,,20,10,,5.37,26.86,,,percent of total billed charges,26.86% of total billed charges,15,75,,,percent of total billed charges,75% of total billed charges ,15,75,,,percent of total billed charges,75% of total billed charges ,4.8,24,,,percent of total billed charges,24% of total billed charges ,15,75,,,percent of total billed charges,75% of total billed charges ,15,75,,,percent of total billed charges,75% of total billed charges ,16,80,,,percent of total billed charges,80% of total billed charges ,4.85,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,15,75,,,percent of total billed charges,75% of total billed charges ,4.9,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.37,26.86,,,percent of total billed charges,26.86% of total billed charges,4.8,24,,,percent of total billed charges,24% of total billed charges ,6.24,31.2,,,percent of total billed charges,31.2% of total billed charges,16,80,,,percent of total billed charges,80% of total billed charges,4.8,24,,,percent of total billed charges,24% of total billed charges ,4.8,24,,,percent of total billed charges,24% of total billed charges ,4.8,16,
ZZZSYNTHROID (LEVOTHYROXINE) 150MCG TB,7027100,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
SYNTHROID (LEVOTHYROXINE) 50MCG TB,7027105,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
SYNTHROID (LEVOTHYROXINE) 75MCG TAB,7027106,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
SYNTHROID (LEVOTHYROXINE) 175MCG TB,7027115,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
SODIUM CHLORIDE 1GM TAB,7027168,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
TAPAZOLE (METHIMAZOLE) 10MG TAB,7027195,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZTAVIST (CLEMASTINE) 2.68MG TAB,7027210,CDM,250,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ZZZTEGRETOL (CARBAMAZEPINE) 100MG TAB,7027240,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
TEGRETOL (CARBAMAZEPINE) 200MG TAB,7027250,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
THIAMINE (VITAMIN B-1) 100MG TAB,7027340,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
THORAZINE (CHLORPROMAZINE) 25MG TAB,7027360,CDM,250,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
TENORMIN (ATENOLOL) 50MG TAB,7027400,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
TESSALON (BENZONATATE) 100MG CAP,7027433,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZTRENTAL (PENTOXIFYLLINE ER) 400MG TB,7027500,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
TYLENOL (ACETAMINOP) 325MG TAB,7027580,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
TYLENOL (ACETAMINOP) 500MG TAB,7027590,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
THEO-24  (THEOPHYLLINE ER) 400MG TB,7027619,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
CALAN (VERAPAMIL) 80MG TAB,7027670,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
CALAN SR (VERAPAMIL ER) 120MG TAB,7027680,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
CALAN SR (VERAPAMIL ER) 240MG TAB,7027690,CDM,250,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
VANCOMYCIN 250MG CAP,7027703,CDM,250,RC,,,Outpatient,,,287.5,143.75,,77.22,26.86,,,percent of total billed charges,26.86% of total billed charges,215.63,75,,,percent of total billed charges,75% of total billed charges ,215.63,75,,,percent of total billed charges,75% of total billed charges ,69,24,,,percent of total billed charges,24% of total billed charges ,215.63,75,,,percent of total billed charges,75% of total billed charges ,215.63,75,,,percent of total billed charges,75% of total billed charges ,230,80,,,percent of total billed charges,80% of total billed charges ,69.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,144.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,215.63,75,,,percent of total billed charges,75% of total billed charges ,70.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,77.22,26.86,,,percent of total billed charges,26.86% of total billed charges,69,24,,,percent of total billed charges,24% of total billed charges ,89.7,31.2,,,percent of total billed charges,31.2% of total billed charges,230,80,,,percent of total billed charges,80% of total billed charges,69,24,,,percent of total billed charges,24% of total billed charges ,69,24,,,percent of total billed charges,24% of total billed charges ,69,230,
ZZZVASOTEC (ENALAPRIL) 5MG TAB,7027710,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
VIBRAMYCIN (DOXYCYCLINE) 100MG CAP,7027760,CDM,250,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
VISTARIL (HYDROXYZINE PAM) 25MG CAP,7027790,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
PEN V K (PENICILLIN VK) 500MG TAB,7027820,CDM,636,RC,J2540,HCPCS,Outpatient,,,16.5,8.25,,0.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,0.77,13.2,
XANAX (ALPRAZOLAM) 0.25MG TAB,7027860,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
XANAX (ALPRAZOLAM) 1MG TAB,7027880,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ZZZZOCOR (SIMVASTATIN) 10MG TAB,7027895,CDM,250,RC,,,Outpatient,,,22.5,11.25,,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,18,
ZZZZOCOR (SIMVASTATIN) 5MG TAB,7027899,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZAROXOLYN (METOLAZONE) 2.5MG TAB,7027900,CDM,250,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ZESTRIL (LISINOPRIL) 5MG TAB,7027925,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZOVIRAX (ACYCLOVIR) 200MG CAP,7027940,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZYLOPRIM (ALLOPURINOL) 100MG TAB,7027950,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZYLOPRIM (ALLOPURINOL) 300MG TAB,7027960,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
VOLTAREN (DICLOFENAC SOD) 0.1% OP SOLU,7028999,CDM,250,RC,,,Outpatient,,,225.5,112.75,,60.57,26.86,,,percent of total billed charges,26.86% of total billed charges,169.13,75,,,percent of total billed charges,75% of total billed charges ,169.13,75,,,percent of total billed charges,75% of total billed charges ,54.12,24,,,percent of total billed charges,24% of total billed charges ,169.13,75,,,percent of total billed charges,75% of total billed charges ,169.13,75,,,percent of total billed charges,75% of total billed charges ,180.4,80,,,percent of total billed charges,80% of total billed charges ,54.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,113.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,169.13,75,,,percent of total billed charges,75% of total billed charges ,55.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,60.57,26.86,,,percent of total billed charges,26.86% of total billed charges,54.12,24,,,percent of total billed charges,24% of total billed charges ,70.36,31.2,,,percent of total billed charges,31.2% of total billed charges,180.4,80,,,percent of total billed charges,80% of total billed charges,54.12,24,,,percent of total billed charges,24% of total billed charges ,54.12,24,,,percent of total billed charges,24% of total billed charges ,54.12,180.4,
MAALOX (MAG/AL/SIME) LIQ 30ML UD,7031029,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
POTASSIUM CHLOR 10% 20MEQ/15ML UD,7031049,CDM,250,RC,,,Outpatient,,,120.5,60.25,,32.37,26.86,,,percent of total billed charges,26.86% of total billed charges,90.38,75,,,percent of total billed charges,75% of total billed charges ,90.38,75,,,percent of total billed charges,75% of total billed charges ,28.92,24,,,percent of total billed charges,24% of total billed charges ,90.38,75,,,percent of total billed charges,75% of total billed charges ,90.38,75,,,percent of total billed charges,75% of total billed charges ,96.4,80,,,percent of total billed charges,80% of total billed charges ,29.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,90.38,75,,,percent of total billed charges,75% of total billed charges ,29.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.37,26.86,,,percent of total billed charges,26.86% of total billed charges,28.92,24,,,percent of total billed charges,24% of total billed charges ,37.6,31.2,,,percent of total billed charges,31.2% of total billed charges,96.4,80,,,percent of total billed charges,80% of total billed charges,28.92,24,,,percent of total billed charges,24% of total billed charges ,28.92,24,,,percent of total billed charges,24% of total billed charges ,28.92,96.4,
MILK OF MAGNESIA SUSP 30ML UD,7031079,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
TYLENOL (ACETAMINOP) 325/10.15 ELIX,7031089,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ZZZPULMOCARE 237ML BOTTLE,7031106,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ENSURE PLUS 237ML BOTTLE,7031144,CDM,272,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
GLUCERNA 1.2 1000ML BOTTLE,7031152,CDM,250,RC,,,Outpatient,,,74,37,,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,55.5,75,,,percent of total billed charges,75% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,59.2,80,,,percent of total billed charges,80% of total billed charges ,17.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,18.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,23.09,31.2,,,percent of total billed charges,31.2% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,59.2,
NEPRO (IMPAIRED RENAL) 237ML BOTTLE,7031186,CDM,250,RC,,,Outpatient,,,29,14.5,,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,23.2,80,,,percent of total billed charges,80% of total billed charges ,7.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,7.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,9.05,31.2,,,percent of total billed charges,31.2% of total billed charges,23.2,80,,,percent of total billed charges,80% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,23.2,
ZZZTINCTURE OF BENZOIN SPRAY BOTTLE,7031429,CDM,250,RC,,,Outpatient,,,64,32,,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,51.2,
PRO-STAT LIQUID PROTEIN 30ML UD,7034595,CDM,250,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ZZZLUMIGAN (BIMATOPROST) 0.01% OP SOL,7034700,CDM,250,RC,,,Outpatient,,,819,409.5,,219.98,26.86,,,percent of total billed charges,26.86% of total billed charges,614.25,75,,,percent of total billed charges,75% of total billed charges ,614.25,75,,,percent of total billed charges,75% of total billed charges ,196.56,24,,,percent of total billed charges,24% of total billed charges ,614.25,75,,,percent of total billed charges,75% of total billed charges ,614.25,75,,,percent of total billed charges,75% of total billed charges ,655.2,80,,,percent of total billed charges,80% of total billed charges ,198.53,24.24,,,percent of total billed charges,24.24% of total billed charges ,412.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,614.25,75,,,percent of total billed charges,75% of total billed charges ,200.49,24.48,,,percent of total billed charges,24.48% of total billed charges ,219.98,26.86,,,percent of total billed charges,26.86% of total billed charges,196.56,24,,,percent of total billed charges,24% of total billed charges ,255.53,31.2,,,percent of total billed charges,31.2% of total billed charges,655.2,80,,,percent of total billed charges,80% of total billed charges,196.56,24,,,percent of total billed charges,24% of total billed charges ,196.56,24,,,percent of total billed charges,24% of total billed charges ,196.56,655.2,
KEPPRA (LEVETIRACETAM) 500MG INJ,7034805,CDM,636,RC,J1953,HCPCS,Outpatient,,,74,37,,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,59.2,80,,,percent of total billed charges,80% of total billed charges ,17.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,18.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,23.09,31.2,,,percent of total billed charges,31.2% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,59.2,
ZZZMEDROL DOSEPAK (METHYLPRED) 4MG TAB,7034910,CDM,250,RC,,,Outpatient,,,155.5,77.75,,41.77,26.86,,,percent of total billed charges,26.86% of total billed charges,116.63,75,,,percent of total billed charges,75% of total billed charges ,116.63,75,,,percent of total billed charges,75% of total billed charges ,37.32,24,,,percent of total billed charges,24% of total billed charges ,116.63,75,,,percent of total billed charges,75% of total billed charges ,116.63,75,,,percent of total billed charges,75% of total billed charges ,124.4,80,,,percent of total billed charges,80% of total billed charges ,37.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,78.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,116.63,75,,,percent of total billed charges,75% of total billed charges ,38.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,41.77,26.86,,,percent of total billed charges,26.86% of total billed charges,37.32,24,,,percent of total billed charges,24% of total billed charges ,48.52,31.2,,,percent of total billed charges,31.2% of total billed charges,124.4,80,,,percent of total billed charges,80% of total billed charges,37.32,24,,,percent of total billed charges,24% of total billed charges ,37.32,24,,,percent of total billed charges,24% of total billed charges ,37.32,124.4,
ZZZACULAR (KETOROLAC 0.4%) OPTH SOL,7035000,CDM,250,RC,,,Outpatient,,,244,122,,65.54,26.86,,,percent of total billed charges,26.86% of total billed charges,183,75,,,percent of total billed charges,75% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,58.56,24,,,percent of total billed charges,24% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,195.2,80,,,percent of total billed charges,80% of total billed charges ,59.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,122.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,59.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,65.54,26.86,,,percent of total billed charges,26.86% of total billed charges,58.56,24,,,percent of total billed charges,24% of total billed charges ,76.13,31.2,,,percent of total billed charges,31.2% of total billed charges,195.2,80,,,percent of total billed charges,80% of total billed charges,58.56,24,,,percent of total billed charges,24% of total billed charges ,58.56,24,,,percent of total billed charges,24% of total billed charges ,58.56,195.2,
ZZZMEFOXITIN (CEFOXITIN) 2GM INJ,7035015,CDM,636,RC,J0694,HCPCS,Outpatient,,,69,34.5,,5.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.2,80,,,percent of total billed charges,80% of total billed charges ,16.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.56,24,,,percent of total billed charges,24% of total billed charges ,21.53,31.2,,,percent of total billed charges,31.2% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,5.08,55.2,
ZZZBETAGAN (LEVOBUNOLOL 0.5%) OPTH 5ML,7035017,CDM,250,RC,,,Outpatient,,,61,30.5,,16.38,26.86,,,percent of total billed charges,26.86% of total billed charges,45.75,75,,,percent of total billed charges,75% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,14.64,24,,,percent of total billed charges,24% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,48.8,80,,,percent of total billed charges,80% of total billed charges ,14.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,30.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,45.75,75,,,percent of total billed charges,75% of total billed charges ,14.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.38,26.86,,,percent of total billed charges,26.86% of total billed charges,14.64,24,,,percent of total billed charges,24% of total billed charges ,19.03,31.2,,,percent of total billed charges,31.2% of total billed charges,48.8,80,,,percent of total billed charges,80% of total billed charges,14.64,24,,,percent of total billed charges,24% of total billed charges ,14.64,24,,,percent of total billed charges,24% of total billed charges ,14.64,48.8,
ATROPINE SULF 1% OPTH SOL,7035019,CDM,250,RC,,,Outpatient,,,279,139.5,,74.94,26.86,,,percent of total billed charges,26.86% of total billed charges,209.25,75,,,percent of total billed charges,75% of total billed charges ,209.25,75,,,percent of total billed charges,75% of total billed charges ,66.96,24,,,percent of total billed charges,24% of total billed charges ,209.25,75,,,percent of total billed charges,75% of total billed charges ,209.25,75,,,percent of total billed charges,75% of total billed charges ,223.2,80,,,percent of total billed charges,80% of total billed charges ,67.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,140.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,209.25,75,,,percent of total billed charges,75% of total billed charges ,68.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,74.94,26.86,,,percent of total billed charges,26.86% of total billed charges,66.96,24,,,percent of total billed charges,24% of total billed charges ,87.05,31.2,,,percent of total billed charges,31.2% of total billed charges,223.2,80,,,percent of total billed charges,80% of total billed charges,66.96,24,,,percent of total billed charges,24% of total billed charges ,66.96,24,,,percent of total billed charges,24% of total billed charges ,66.96,223.2,
CIPROFLOXACIN 0.3% OPTH SOLUTION,7035022,CDM,250,RC,,,Outpatient,,,72,36,,19.34,26.86,,,percent of total billed charges,26.86% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.34,26.86,,,percent of total billed charges,26.86% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,57.6,
CORTISPORIN ( B/NEO/POLY/HC) OP SOL,7035029,CDM,250,RC,,,Outpatient,,,287.5,143.75,,77.22,26.86,,,percent of total billed charges,26.86% of total billed charges,215.63,75,,,percent of total billed charges,75% of total billed charges ,215.63,75,,,percent of total billed charges,75% of total billed charges ,69,24,,,percent of total billed charges,24% of total billed charges ,215.63,75,,,percent of total billed charges,75% of total billed charges ,215.63,75,,,percent of total billed charges,75% of total billed charges ,230,80,,,percent of total billed charges,80% of total billed charges ,69.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,144.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,215.63,75,,,percent of total billed charges,75% of total billed charges ,70.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,77.22,26.86,,,percent of total billed charges,26.86% of total billed charges,69,24,,,percent of total billed charges,24% of total billed charges ,89.7,31.2,,,percent of total billed charges,31.2% of total billed charges,230,80,,,percent of total billed charges,80% of total billed charges,69,24,,,percent of total billed charges,24% of total billed charges ,69,24,,,percent of total billed charges,24% of total billed charges ,69,230,
CORTISPORIN (B/NEO/POLY/HC) OP OINT,7035039,CDM,250,RC,,,Outpatient,,,322.5,161.25,,86.62,26.86,,,percent of total billed charges,26.86% of total billed charges,241.88,75,,,percent of total billed charges,75% of total billed charges ,241.88,75,,,percent of total billed charges,75% of total billed charges ,77.4,24,,,percent of total billed charges,24% of total billed charges ,241.88,75,,,percent of total billed charges,75% of total billed charges ,241.88,75,,,percent of total billed charges,75% of total billed charges ,258,80,,,percent of total billed charges,80% of total billed charges ,78.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,162.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,241.88,75,,,percent of total billed charges,75% of total billed charges ,78.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,86.62,26.86,,,percent of total billed charges,26.86% of total billed charges,77.4,24,,,percent of total billed charges,24% of total billed charges ,100.62,31.2,,,percent of total billed charges,31.2% of total billed charges,258,80,,,percent of total billed charges,80% of total billed charges,77.4,24,,,percent of total billed charges,24% of total billed charges ,77.4,24,,,percent of total billed charges,24% of total billed charges ,77.4,258,
DECADRON (DEXAMETHASONE) 0.1% O.S.,7035044,CDM,250,RC,,,Outpatient,,,320.5,160.25,,86.09,26.86,,,percent of total billed charges,26.86% of total billed charges,240.38,75,,,percent of total billed charges,75% of total billed charges ,240.38,75,,,percent of total billed charges,75% of total billed charges ,76.92,24,,,percent of total billed charges,24% of total billed charges ,240.38,75,,,percent of total billed charges,75% of total billed charges ,240.38,75,,,percent of total billed charges,75% of total billed charges ,256.4,80,,,percent of total billed charges,80% of total billed charges ,77.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,161.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,240.38,75,,,percent of total billed charges,75% of total billed charges ,78.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,86.09,26.86,,,percent of total billed charges,26.86% of total billed charges,76.92,24,,,percent of total billed charges,24% of total billed charges ,100,31.2,,,percent of total billed charges,31.2% of total billed charges,256.4,80,,,percent of total billed charges,80% of total billed charges,76.92,24,,,percent of total billed charges,24% of total billed charges ,76.92,24,,,percent of total billed charges,24% of total billed charges ,76.92,256.4,
ERYTHROMYCIN 0.5% OPTH OINT 3.5G,7035049,CDM,250,RC,,,Outpatient,,,109,54.5,,29.28,26.86,,,percent of total billed charges,26.86% of total billed charges,81.75,75,,,percent of total billed charges,75% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,26.16,24,,,percent of total billed charges,24% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,87.2,80,,,percent of total billed charges,80% of total billed charges ,26.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,26.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.28,26.86,,,percent of total billed charges,26.86% of total billed charges,26.16,24,,,percent of total billed charges,24% of total billed charges ,34.01,31.2,,,percent of total billed charges,31.2% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,26.16,24,,,percent of total billed charges,24% of total billed charges ,26.16,24,,,percent of total billed charges,24% of total billed charges ,26.16,87.2,
ZZZFLAREX (FLUOROMETHOLONE) 0.1% O.S.,7035053,CDM,250,RC,,,Outpatient,,,390.5,195.25,,104.89,26.86,,,percent of total billed charges,26.86% of total billed charges,292.88,75,,,percent of total billed charges,75% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,93.72,24,,,percent of total billed charges,24% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,312.4,80,,,percent of total billed charges,80% of total billed charges ,94.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,196.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,95.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,104.89,26.86,,,percent of total billed charges,26.86% of total billed charges,93.72,24,,,percent of total billed charges,24% of total billed charges ,121.84,31.2,,,percent of total billed charges,31.2% of total billed charges,312.4,80,,,percent of total billed charges,80% of total billed charges,93.72,24,,,percent of total billed charges,24% of total billed charges ,93.72,24,,,percent of total billed charges,24% of total billed charges ,93.72,312.4,
GENTAMYCIN 0.3% OPTH SOL 5ML,7035069,CDM,250,RC,,,Outpatient,,,115.5,57.75,,31.02,26.86,,,percent of total billed charges,26.86% of total billed charges,86.63,75,,,percent of total billed charges,75% of total billed charges ,86.63,75,,,percent of total billed charges,75% of total billed charges ,27.72,24,,,percent of total billed charges,24% of total billed charges ,86.63,75,,,percent of total billed charges,75% of total billed charges ,86.63,75,,,percent of total billed charges,75% of total billed charges ,92.4,80,,,percent of total billed charges,80% of total billed charges ,28,24.24,,,percent of total billed charges,24.24% of total billed charges ,58.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,86.63,75,,,percent of total billed charges,75% of total billed charges ,28.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.02,26.86,,,percent of total billed charges,26.86% of total billed charges,27.72,24,,,percent of total billed charges,24% of total billed charges ,36.04,31.2,,,percent of total billed charges,31.2% of total billed charges,92.4,80,,,percent of total billed charges,80% of total billed charges,27.72,24,,,percent of total billed charges,24% of total billed charges ,27.72,24,,,percent of total billed charges,24% of total billed charges ,27.72,92.4,
EYE OPTH OINT 3.5GM,7035089,CDM,250,RC,,,Outpatient,,,29,14.5,,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,23.2,80,,,percent of total billed charges,80% of total billed charges ,7.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,7.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,9.05,31.2,,,percent of total billed charges,31.2% of total billed charges,23.2,80,,,percent of total billed charges,80% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,23.2,
ZZZMYDRIACIL (TROPICAMIDE 1%) OPTH SOL,7035119,CDM,250,RC,,,Outpatient,,,59.5,29.75,,15.98,26.86,,,percent of total billed charges,26.86% of total billed charges,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.98,26.86,,,percent of total billed charges,26.86% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,47.6,
MURO-128 (5% SOD CHL) OPTH SOLN,7035129,CDM,250,RC,,,Outpatient,,,70,35,,18.8,26.86,,,percent of total billed charges,26.86% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,16.8,24,,,percent of total billed charges,24% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,56,80,,,percent of total billed charges,80% of total billed charges ,16.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,17.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.8,26.86,,,percent of total billed charges,26.86% of total billed charges,16.8,24,,,percent of total billed charges,24% of total billed charges ,21.84,31.2,,,percent of total billed charges,31.2% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,16.8,24,,,percent of total billed charges,24% of total billed charges ,16.8,24,,,percent of total billed charges,24% of total billed charges ,16.8,56,
ZZZVISINE-A (NAPHAZOLINE) OPTH SOLN,7035130,CDM,250,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
FUL-GLO (FLUORESCEIN SOD) 1MG OP STRP,7035155,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
PHENYLEPHRINE 10% OPTH SOL,7035159,CDM,250,RC,,,Outpatient,,,241,120.5,,64.73,26.86,,,percent of total billed charges,26.86% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges ,180.75,75,,,percent of total billed charges,75% of total billed charges ,57.84,24,,,percent of total billed charges,24% of total billed charges ,180.75,75,,,percent of total billed charges,75% of total billed charges ,180.75,75,,,percent of total billed charges,75% of total billed charges ,192.8,80,,,percent of total billed charges,80% of total billed charges ,58.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,121.46,50.4,,,percent of total billed charges,50.4% of total billed charges ,180.75,75,,,percent of total billed charges,75% of total billed charges ,59,24.48,,,percent of total billed charges,24.48% of total billed charges ,64.73,26.86,,,percent of total billed charges,26.86% of total billed charges,57.84,24,,,percent of total billed charges,24% of total billed charges ,75.19,31.2,,,percent of total billed charges,31.2% of total billed charges,192.8,80,,,percent of total billed charges,80% of total billed charges,57.84,24,,,percent of total billed charges,24% of total billed charges ,57.84,24,,,percent of total billed charges,24% of total billed charges ,57.84,192.8,
ZZZNEOSPORIN (/NEOM/POLYM/GRAM) OPTH SOL,7035169,CDM,250,RC,,,Outpatient,,,305,152.5,,81.92,26.86,,,percent of total billed charges,26.86% of total billed charges,228.75,75,,,percent of total billed charges,75% of total billed charges ,228.75,75,,,percent of total billed charges,75% of total billed charges ,73.2,24,,,percent of total billed charges,24% of total billed charges ,228.75,75,,,percent of total billed charges,75% of total billed charges ,228.75,75,,,percent of total billed charges,75% of total billed charges ,244,80,,,percent of total billed charges,80% of total billed charges ,73.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,153.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,228.75,75,,,percent of total billed charges,75% of total billed charges ,74.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,81.92,26.86,,,percent of total billed charges,26.86% of total billed charges,73.2,24,,,percent of total billed charges,24% of total billed charges ,95.16,31.2,,,percent of total billed charges,31.2% of total billed charges,244,80,,,percent of total billed charges,80% of total billed charges,73.2,24,,,percent of total billed charges,24% of total billed charges ,73.2,24,,,percent of total billed charges,24% of total billed charges ,73.2,244,
NEOSPORIN (NEOM/POLYM/BACIT) OPTH OINT,7035179,CDM,250,RC,,,Outpatient,,,262.5,131.25,,70.51,26.86,,,percent of total billed charges,26.86% of total billed charges,196.88,75,,,percent of total billed charges,75% of total billed charges ,196.88,75,,,percent of total billed charges,75% of total billed charges ,63,24,,,percent of total billed charges,24% of total billed charges ,196.88,75,,,percent of total billed charges,75% of total billed charges ,196.88,75,,,percent of total billed charges,75% of total billed charges ,210,80,,,percent of total billed charges,80% of total billed charges ,63.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,132.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,196.88,75,,,percent of total billed charges,75% of total billed charges ,64.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,70.51,26.86,,,percent of total billed charges,26.86% of total billed charges,63,24,,,percent of total billed charges,24% of total billed charges ,81.9,31.2,,,percent of total billed charges,31.2% of total billed charges,210,80,,,percent of total billed charges,80% of total billed charges,63,24,,,percent of total billed charges,24% of total billed charges ,63,24,,,percent of total billed charges,24% of total billed charges ,63,210,
ZZZPILOCARPINE HCL 1% OPTH SOLN 15ML,7035199,CDM,250,RC,,,Outpatient,,,482,241,,129.47,26.86,,,percent of total billed charges,26.86% of total billed charges,361.5,75,,,percent of total billed charges,75% of total billed charges ,361.5,75,,,percent of total billed charges,75% of total billed charges ,115.68,24,,,percent of total billed charges,24% of total billed charges ,361.5,75,,,percent of total billed charges,75% of total billed charges ,361.5,75,,,percent of total billed charges,75% of total billed charges ,385.6,80,,,percent of total billed charges,80% of total billed charges ,116.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,242.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,361.5,75,,,percent of total billed charges,75% of total billed charges ,117.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,129.47,26.86,,,percent of total billed charges,26.86% of total billed charges,115.68,24,,,percent of total billed charges,24% of total billed charges ,150.38,31.2,,,percent of total billed charges,31.2% of total billed charges,385.6,80,,,percent of total billed charges,80% of total billed charges,115.68,24,,,percent of total billed charges,24% of total billed charges ,115.68,24,,,percent of total billed charges,24% of total billed charges ,115.68,385.6,
MUCOMYST (ACETYLCYSTEINE) 10% SOLU 30ML,7035225,CDM,250,RC,,,Outpatient,,,110.25,55.13,,29.61,26.86,,,percent of total billed charges,26.86% of total billed charges,82.69,75,,,percent of total billed charges,75% of total billed charges ,82.69,75,,,percent of total billed charges,75% of total billed charges ,26.46,24,,,percent of total billed charges,24% of total billed charges ,82.69,75,,,percent of total billed charges,75% of total billed charges ,82.69,75,,,percent of total billed charges,75% of total billed charges ,88.2,80,,,percent of total billed charges,80% of total billed charges ,26.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.57,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.69,75,,,percent of total billed charges,75% of total billed charges ,26.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.61,26.86,,,percent of total billed charges,26.86% of total billed charges,26.46,24,,,percent of total billed charges,24% of total billed charges ,34.4,31.2,,,percent of total billed charges,31.2% of total billed charges,88.2,80,,,percent of total billed charges,80% of total billed charges,26.46,24,,,percent of total billed charges,24% of total billed charges ,26.46,24,,,percent of total billed charges,24% of total billed charges ,26.46,88.2,
PRED FORTE (PREDNISOLONE AC) 1% O.S.,7035229,CDM,250,RC,,,Outpatient,,,263.5,131.75,,70.78,26.86,,,percent of total billed charges,26.86% of total billed charges,197.63,75,,,percent of total billed charges,75% of total billed charges ,197.63,75,,,percent of total billed charges,75% of total billed charges ,63.24,24,,,percent of total billed charges,24% of total billed charges ,197.63,75,,,percent of total billed charges,75% of total billed charges ,197.63,75,,,percent of total billed charges,75% of total billed charges ,210.8,80,,,percent of total billed charges,80% of total billed charges ,63.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,132.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,197.63,75,,,percent of total billed charges,75% of total billed charges ,64.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,70.78,26.86,,,percent of total billed charges,26.86% of total billed charges,63.24,24,,,percent of total billed charges,24% of total billed charges ,82.21,31.2,,,percent of total billed charges,31.2% of total billed charges,210.8,80,,,percent of total billed charges,80% of total billed charges,63.24,24,,,percent of total billed charges,24% of total billed charges ,63.24,24,,,percent of total billed charges,24% of total billed charges ,63.24,210.8,
ZZZSULFACETAMIDE &PRED10-0.25%OPTH  5ML,7035242,CDM,250,RC,,,Outpatient,,,102,51,,27.4,26.86,,,percent of total billed charges,26.86% of total billed charges,76.5,75,,,percent of total billed charges,75% of total billed charges ,76.5,75,,,percent of total billed charges,75% of total billed charges ,24.48,24,,,percent of total billed charges,24% of total billed charges ,76.5,75,,,percent of total billed charges,75% of total billed charges ,76.5,75,,,percent of total billed charges,75% of total billed charges ,81.6,80,,,percent of total billed charges,80% of total billed charges ,24.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,51.41,50.4,,,percent of total billed charges,50.4% of total billed charges ,76.5,75,,,percent of total billed charges,75% of total billed charges ,24.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.4,26.86,,,percent of total billed charges,26.86% of total billed charges,24.48,24,,,percent of total billed charges,24% of total billed charges ,31.82,31.2,,,percent of total billed charges,31.2% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,24.48,24,,,percent of total billed charges,24% of total billed charges ,24.48,24,,,percent of total billed charges,24% of total billed charges ,24.48,81.6,
ZZZTETRACAINE 0.5% OPTH SOLN 15ML,7035249,CDM,250,RC,,,Outpatient,,,63,31.5,,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,50.4,
TEARS NATURAL (ARTIFICIAL TEARS) UD,7035255,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
TOBRADEX (TOBRAM/DEX) OPTH SUSP,7035257,CDM,250,RC,,,Outpatient,,,302,151,,81.12,26.86,,,percent of total billed charges,26.86% of total billed charges,226.5,75,,,percent of total billed charges,75% of total billed charges ,226.5,75,,,percent of total billed charges,75% of total billed charges ,72.48,24,,,percent of total billed charges,24% of total billed charges ,226.5,75,,,percent of total billed charges,75% of total billed charges ,226.5,75,,,percent of total billed charges,75% of total billed charges ,241.6,80,,,percent of total billed charges,80% of total billed charges ,73.2,24.24,,,percent of total billed charges,24.24% of total billed charges ,152.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,226.5,75,,,percent of total billed charges,75% of total billed charges ,73.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,81.12,26.86,,,percent of total billed charges,26.86% of total billed charges,72.48,24,,,percent of total billed charges,24% of total billed charges ,94.22,31.2,,,percent of total billed charges,31.2% of total billed charges,241.6,80,,,percent of total billed charges,80% of total billed charges,72.48,24,,,percent of total billed charges,24% of total billed charges ,72.48,24,,,percent of total billed charges,24% of total billed charges ,72.48,241.6,
TIMOPTIC (TIMOLOL) 0.5% OPTH SOL,7035269,CDM,250,RC,,,Outpatient,,,92.5,46.25,,24.85,26.86,,,percent of total billed charges,26.86% of total billed charges,69.38,75,,,percent of total billed charges,75% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,22.2,24,,,percent of total billed charges,24% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,74,80,,,percent of total billed charges,80% of total billed charges ,22.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,46.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,22.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.85,26.86,,,percent of total billed charges,26.86% of total billed charges,22.2,24,,,percent of total billed charges,24% of total billed charges ,28.86,31.2,,,percent of total billed charges,31.2% of total billed charges,74,80,,,percent of total billed charges,80% of total billed charges,22.2,24,,,percent of total billed charges,24% of total billed charges ,22.2,24,,,percent of total billed charges,24% of total billed charges ,22.2,74,
SULF-PRED 10-0.23% OPTH SOLN 5ML,7035279,CDM,250,RC,,,Outpatient,,,101,50.5,,27.13,26.86,,,percent of total billed charges,26.86% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.13,26.86,,,percent of total billed charges,26.86% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,80.8,
VISINE (TETRAHYDROZOLINE) OPTH SOL,7035319,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ATROVENT HFA (IPRATROPIUM) INHALER,7035339,CDM,250,RC,,,Outpatient,,,1624.5,812.25,,436.34,26.86,,,percent of total billed charges,26.86% of total billed charges,1218.38,75,,,percent of total billed charges,75% of total billed charges ,1218.38,75,,,percent of total billed charges,75% of total billed charges ,389.88,24,,,percent of total billed charges,24% of total billed charges ,1218.38,75,,,percent of total billed charges,75% of total billed charges ,1218.38,75,,,percent of total billed charges,75% of total billed charges ,1299.6,80,,,percent of total billed charges,80% of total billed charges ,393.78,24.24,,,percent of total billed charges,24.24% of total billed charges ,818.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,1218.38,75,,,percent of total billed charges,75% of total billed charges ,397.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,436.34,26.86,,,percent of total billed charges,26.86% of total billed charges,389.88,24,,,percent of total billed charges,24% of total billed charges ,506.84,31.2,,,percent of total billed charges,31.2% of total billed charges,1299.6,80,,,percent of total billed charges,80% of total billed charges,389.88,24,,,percent of total billed charges,24% of total billed charges ,389.88,24,,,percent of total billed charges,24% of total billed charges ,389.88,1299.6,
ATROVENT (IPRATROPIUM) 0.5MG/VIAL NEB,7035340,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
AMMONIA 15% INHALANT,7035349,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
LACTINEX (ACIDOPHILUS) GRANULES PKT,7035435,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
NEO-SYNEPHRINE (PHENYLEPH) 0.25% SPR,7035490,CDM,250,RC,,,Outpatient,,,30,15,,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,24,80,,,percent of total billed charges,80% of total billed charges ,7.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,,,percent of total billed charges,31.2% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,
WELLBUTRIN (BUPROPION SR) 100MG TB,7035540,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
AFRIN (OXYMETAZOLINE HCL) NASAL SPRAY,7035570,CDM,250,RC,,,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
ZZZBETOPTIC-S (BETAXOLOL) 0.25% OP SOL,7035594,CDM,250,RC,,,Outpatient,,,1403,701.5,,376.85,26.86,,,percent of total billed charges,26.86% of total billed charges,1052.25,75,,,percent of total billed charges,75% of total billed charges ,1052.25,75,,,percent of total billed charges,75% of total billed charges ,336.72,24,,,percent of total billed charges,24% of total billed charges ,1052.25,75,,,percent of total billed charges,75% of total billed charges ,1052.25,75,,,percent of total billed charges,75% of total billed charges ,1122.4,80,,,percent of total billed charges,80% of total billed charges ,340.09,24.24,,,percent of total billed charges,24.24% of total billed charges ,707.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,1052.25,75,,,percent of total billed charges,75% of total billed charges ,343.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,376.85,26.86,,,percent of total billed charges,26.86% of total billed charges,336.72,24,,,percent of total billed charges,24% of total billed charges ,437.74,31.2,,,percent of total billed charges,31.2% of total billed charges,1122.4,80,,,percent of total billed charges,80% of total billed charges,336.72,24,,,percent of total billed charges,24% of total billed charges ,336.72,24,,,percent of total billed charges,24% of total billed charges ,336.72,1122.4,
VENTOLIN HFA (ALBUTEROL) 90MCG INHALER,7035625,CDM,250,RC,,,Outpatient,,,394.5,197.25,,105.96,26.86,,,percent of total billed charges,26.86% of total billed charges,295.88,75,,,percent of total billed charges,75% of total billed charges ,295.88,75,,,percent of total billed charges,75% of total billed charges ,94.68,24,,,percent of total billed charges,24% of total billed charges ,295.88,75,,,percent of total billed charges,75% of total billed charges ,295.88,75,,,percent of total billed charges,75% of total billed charges ,315.6,80,,,percent of total billed charges,80% of total billed charges ,95.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,198.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,295.88,75,,,percent of total billed charges,75% of total billed charges ,96.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,105.96,26.86,,,percent of total billed charges,26.86% of total billed charges,94.68,24,,,percent of total billed charges,24% of total billed charges ,123.08,31.2,,,percent of total billed charges,31.2% of total billed charges,315.6,80,,,percent of total billed charges,80% of total billed charges,94.68,24,,,percent of total billed charges,24% of total billed charges ,94.68,24,,,percent of total billed charges,24% of total billed charges ,94.68,315.6,
ZZZAURODEX (ANTIPYRINE/BENZ) OTIC,7035630,CDM,250,RC,,,Outpatient,,,69,34.5,,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,55.2,80,,,percent of total billed charges,80% of total billed charges ,16.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,21.53,31.2,,,percent of total billed charges,31.2% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,55.2,
ZZZDONNATAL (PHENOB/HYO/ATR/SCOP) 5ML,7035645,CDM,250,RC,,,Outpatient,,,66,33,,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,52.8,80,,,percent of total billed charges,80% of total billed charges ,16,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,16.16,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,20.59,31.2,,,percent of total billed charges,31.2% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,52.8,
CORTISPORIN (B/NEO/POLY/HC) OTIC SOL,7035660,CDM,250,RC,,,Outpatient,,,436.5,218.25,,117.24,26.86,,,percent of total billed charges,26.86% of total billed charges,327.38,75,,,percent of total billed charges,75% of total billed charges ,327.38,75,,,percent of total billed charges,75% of total billed charges ,104.76,24,,,percent of total billed charges,24% of total billed charges ,327.38,75,,,percent of total billed charges,75% of total billed charges ,327.38,75,,,percent of total billed charges,75% of total billed charges ,349.2,80,,,percent of total billed charges,80% of total billed charges ,105.81,24.24,,,percent of total billed charges,24.24% of total billed charges ,220,50.4,,,percent of total billed charges,50.4% of total billed charges ,327.38,75,,,percent of total billed charges,75% of total billed charges ,106.86,24.48,,,percent of total billed charges,24.48% of total billed charges ,117.24,26.86,,,percent of total billed charges,26.86% of total billed charges,104.76,24,,,percent of total billed charges,24% of total billed charges ,136.19,31.2,,,percent of total billed charges,31.2% of total billed charges,349.2,80,,,percent of total billed charges,80% of total billed charges,104.76,24,,,percent of total billed charges,24% of total billed charges ,104.76,24,,,percent of total billed charges,24% of total billed charges ,104.76,349.2,
ZZZCORTISPORIN (B/NEO/POLY/HC) OTIC SUS,7035661,CDM,250,RC,,,Outpatient,,,106,53,,28.47,26.86,,,percent of total billed charges,26.86% of total billed charges,79.5,75,,,percent of total billed charges,75% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,25.44,24,,,percent of total billed charges,24% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,84.8,80,,,percent of total billed charges,80% of total billed charges ,25.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,53.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,25.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.47,26.86,,,percent of total billed charges,26.86% of total billed charges,25.44,24,,,percent of total billed charges,24% of total billed charges ,33.07,31.2,,,percent of total billed charges,31.2% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,25.44,24,,,percent of total billed charges,24% of total billed charges ,25.44,24,,,percent of total billed charges,24% of total billed charges ,25.44,84.8,
ZZZDEBROX (CARBAMIDE PEROXIDE) OTIC DRPS,7035664,CDM,250,RC,,,Outpatient,,,13.5,6.75,,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.8,80,,,percent of total billed charges,80% of total billed charges ,3.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,4.21,31.2,,,percent of total billed charges,31.2% of total billed charges,10.8,80,,,percent of total billed charges,80% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,10.8,
ZZZACETASOL (HYDROCORT/ACETIC) 1-2%,7035680,CDM,250,RC,,,Outpatient,,,837.5,418.75,,224.95,26.86,,,percent of total billed charges,26.86% of total billed charges,628.13,75,,,percent of total billed charges,75% of total billed charges ,628.13,75,,,percent of total billed charges,75% of total billed charges ,201,24,,,percent of total billed charges,24% of total billed charges ,628.13,75,,,percent of total billed charges,75% of total billed charges ,628.13,75,,,percent of total billed charges,75% of total billed charges ,670,80,,,percent of total billed charges,80% of total billed charges ,203.01,24.24,,,percent of total billed charges,24.24% of total billed charges ,422.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,628.13,75,,,percent of total billed charges,75% of total billed charges ,205.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,224.95,26.86,,,percent of total billed charges,26.86% of total billed charges,201,24,,,percent of total billed charges,24% of total billed charges ,261.3,31.2,,,percent of total billed charges,31.2% of total billed charges,670,80,,,percent of total billed charges,80% of total billed charges,201,24,,,percent of total billed charges,24% of total billed charges ,201,24,,,percent of total billed charges,24% of total billed charges ,201,670,
ZZZACETASOL HC (HYDR/ACETIC ACID) 1-2%,7035690,CDM,250,RC,,,Outpatient,,,727,363.5,,195.27,26.86,,,percent of total billed charges,26.86% of total billed charges,545.25,75,,,percent of total billed charges,75% of total billed charges ,545.25,75,,,percent of total billed charges,75% of total billed charges ,174.48,24,,,percent of total billed charges,24% of total billed charges ,545.25,75,,,percent of total billed charges,75% of total billed charges ,545.25,75,,,percent of total billed charges,75% of total billed charges ,581.6,80,,,percent of total billed charges,80% of total billed charges ,176.22,24.24,,,percent of total billed charges,24.24% of total billed charges ,366.41,50.4,,,percent of total billed charges,50.4% of total billed charges ,545.25,75,,,percent of total billed charges,75% of total billed charges ,177.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,195.27,26.86,,,percent of total billed charges,26.86% of total billed charges,174.48,24,,,percent of total billed charges,24% of total billed charges ,226.82,31.2,,,percent of total billed charges,31.2% of total billed charges,581.6,80,,,percent of total billed charges,80% of total billed charges,174.48,24,,,percent of total billed charges,24% of total billed charges ,174.48,24,,,percent of total billed charges,24% of total billed charges ,174.48,581.6,
TYLENOL (ACETAMINOP) 650MG SUPP,7035710,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
TYLENOL (ACETAMINOP) 325MG SUPP,7035720,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
TYLENOL (ACETAMINOP) 120MG SUPP,7035730,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
GLYCERIN (SANI-SUPP) (INFANT)  SUPP,7035780,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
DULCOLAX (BISACODYL) 10MG SUPP,7035790,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
CUBICIN (DAPTOMYCIN) 500MG INJ,7035855,CDM,636,RC,J0878,HCPCS,Outpatient,,,178.5,89.25,,0.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,142.8,80,,,percent of total billed charges,80% of total billed charges ,43.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.88,75,,,percent of total billed charges,75% of total billed charges ,43.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.84,24,,,percent of total billed charges,24% of total billed charges ,55.69,31.2,,,percent of total billed charges,31.2% of total billed charges,142.8,80,,,percent of total billed charges,80% of total billed charges,42.84,24,,,percent of total billed charges,24% of total billed charges ,42.84,24,,,percent of total billed charges,24% of total billed charges ,0.04,142.8,
ANUSOL HC (HYDROCORTISONE) 25MG SUP,7035860,CDM,250,RC,,,Outpatient,,,80.5,40.25,,21.62,26.86,,,percent of total billed charges,26.86% of total billed charges,60.38,75,,,percent of total billed charges,75% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,19.32,24,,,percent of total billed charges,24% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,64.4,80,,,percent of total billed charges,80% of total billed charges ,19.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,40.57,50.4,,,percent of total billed charges,50.4% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,19.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.62,26.86,,,percent of total billed charges,26.86% of total billed charges,19.32,24,,,percent of total billed charges,24% of total billed charges ,25.12,31.2,,,percent of total billed charges,31.2% of total billed charges,64.4,80,,,percent of total billed charges,80% of total billed charges,19.32,24,,,percent of total billed charges,24% of total billed charges ,19.32,24,,,percent of total billed charges,24% of total billed charges ,19.32,64.4,
TRIAMCINOLONE ACETONIDE 0.1% CREAM,7035910,CDM,250,RC,,,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
ZZZTRIAMCINOLONE ACETONIDE 0.1% OINT,7035920,CDM,250,RC,,,Outpatient,,,36,18,,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,28.8,80,,,percent of total billed charges,80% of total billed charges ,8.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,11.23,31.2,,,percent of total billed charges,31.2% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,28.8,
PROCTOSOL HC (HYDROCORTISONE) 2.5% CR,7035928,CDM,250,RC,,,Outpatient,,,428.5,214.25,,115.1,26.86,,,percent of total billed charges,26.86% of total billed charges,321.38,75,,,percent of total billed charges,75% of total billed charges ,321.38,75,,,percent of total billed charges,75% of total billed charges ,102.84,24,,,percent of total billed charges,24% of total billed charges ,321.38,75,,,percent of total billed charges,75% of total billed charges ,321.38,75,,,percent of total billed charges,75% of total billed charges ,342.8,80,,,percent of total billed charges,80% of total billed charges ,103.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,215.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,321.38,75,,,percent of total billed charges,75% of total billed charges ,104.9,24.48,,,percent of total billed charges,24.48% of total billed charges ,115.1,26.86,,,percent of total billed charges,26.86% of total billed charges,102.84,24,,,percent of total billed charges,24% of total billed charges ,133.69,31.2,,,percent of total billed charges,31.2% of total billed charges,342.8,80,,,percent of total billed charges,80% of total billed charges,102.84,24,,,percent of total billed charges,24% of total billed charges ,102.84,24,,,percent of total billed charges,24% of total billed charges ,102.84,342.8,
BACITRACIN 500/14G TUBE,7035938,CDM,250,RC,,,Outpatient,,,28,14,,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,22.4,80,,,percent of total billed charges,80% of total billed charges ,6.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,8.74,31.2,,,percent of total billed charges,31.2% of total billed charges,22.4,80,,,percent of total billed charges,80% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,22.4,
BENADRYL (DIPHENHYDRAMINE) CREAM,7035940,CDM,250,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
MIRALAX (POLYETHYLENE GLYC) 238GM PWD,7035960,CDM,250,RC,,,Outpatient,,,58.5,29.25,,15.71,26.86,,,percent of total billed charges,26.86% of total billed charges,43.88,75,,,percent of total billed charges,75% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.71,26.86,,,percent of total billed charges,26.86% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,46.8,
ZZZCORTISPORIN 1 % TOPICAL OINTMENT,7035980,CDM,250,RC,,,Outpatient,,,668.5,334.25,,179.56,26.86,,,percent of total billed charges,26.86% of total billed charges,501.38,75,,,percent of total billed charges,75% of total billed charges ,501.38,75,,,percent of total billed charges,75% of total billed charges ,160.44,24,,,percent of total billed charges,24% of total billed charges ,501.38,75,,,percent of total billed charges,75% of total billed charges ,501.38,75,,,percent of total billed charges,75% of total billed charges ,534.8,80,,,percent of total billed charges,80% of total billed charges ,162.04,24.24,,,percent of total billed charges,24.24% of total billed charges ,336.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,501.38,75,,,percent of total billed charges,75% of total billed charges ,163.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,179.56,26.86,,,percent of total billed charges,26.86% of total billed charges,160.44,24,,,percent of total billed charges,24% of total billed charges ,208.57,31.2,,,percent of total billed charges,31.2% of total billed charges,534.8,80,,,percent of total billed charges,80% of total billed charges,160.44,24,,,percent of total billed charges,24% of total billed charges ,160.44,24,,,percent of total billed charges,24% of total billed charges ,160.44,534.8,
CORTENEMA (HYCROCORT) ENEMA 60ML,7035990,CDM,250,RC,,,Outpatient,,,63,31.5,,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,50.4,
GENTAMYCIN 0.1% OINTMENT 15GM,7036020,CDM,250,RC,,,Outpatient,,,247,123.5,,66.34,26.86,,,percent of total billed charges,26.86% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,59.28,24,,,percent of total billed charges,24% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,197.6,80,,,percent of total billed charges,80% of total billed charges ,59.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,124.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,60.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,66.34,26.86,,,percent of total billed charges,26.86% of total billed charges,59.28,24,,,percent of total billed charges,24% of total billed charges ,77.06,31.2,,,percent of total billed charges,31.2% of total billed charges,197.6,80,,,percent of total billed charges,80% of total billed charges,59.28,24,,,percent of total billed charges,24% of total billed charges ,59.28,24,,,percent of total billed charges,24% of total billed charges ,59.28,197.6,
ZZZGENTAMYCIN 0.1% CREAM 15GM,7036030,CDM,250,RC,,,Outpatient,,,247,123.5,,66.34,26.86,,,percent of total billed charges,26.86% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,59.28,24,,,percent of total billed charges,24% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,197.6,80,,,percent of total billed charges,80% of total billed charges ,59.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,124.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,60.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,66.34,26.86,,,percent of total billed charges,26.86% of total billed charges,59.28,24,,,percent of total billed charges,24% of total billed charges ,77.06,31.2,,,percent of total billed charges,31.2% of total billed charges,197.6,80,,,percent of total billed charges,80% of total billed charges,59.28,24,,,percent of total billed charges,24% of total billed charges ,59.28,24,,,percent of total billed charges,24% of total billed charges ,59.28,197.6,
LEVSIN (HYOSCYAMINE SULF) 0.125MG SL,7036065,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ELIMITE (PERMETHRIN) 5 % TOPICAL CRM,7036085,CDM,250,RC,,,Outpatient,,,528.5,264.25,,141.96,26.86,,,percent of total billed charges,26.86% of total billed charges,396.38,75,,,percent of total billed charges,75% of total billed charges ,396.38,75,,,percent of total billed charges,75% of total billed charges ,126.84,24,,,percent of total billed charges,24% of total billed charges ,396.38,75,,,percent of total billed charges,75% of total billed charges ,396.38,75,,,percent of total billed charges,75% of total billed charges ,422.8,80,,,percent of total billed charges,80% of total billed charges ,128.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,266.36,50.4,,,percent of total billed charges,50.4% of total billed charges ,396.38,75,,,percent of total billed charges,75% of total billed charges ,129.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,141.96,26.86,,,percent of total billed charges,26.86% of total billed charges,126.84,24,,,percent of total billed charges,24% of total billed charges ,164.89,31.2,,,percent of total billed charges,31.2% of total billed charges,422.8,80,,,percent of total billed charges,80% of total billed charges,126.84,24,,,percent of total billed charges,24% of total billed charges ,126.84,24,,,percent of total billed charges,24% of total billed charges ,126.84,422.8,
ZZZEUCERIN (PETROLIUM/MINERAL OIL) CRM,7036117,CDM,250,RC,,,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
HYDROGEN PEROXIDE 3% BOTTLE,7036120,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ANUSOL HC (HYDROCORTISONE) 2.5% CREAM,7036130,CDM,250,RC,,,Outpatient,,,424.5,212.25,,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,339.6,80,,,percent of total billed charges,80% of total billed charges ,102.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,213.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,103.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,132.44,31.2,,,percent of total billed charges,31.2% of total billed charges,339.6,80,,,percent of total billed charges,80% of total billed charges,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,24,,,percent of total billed charges,24% of total billed charges ,101.88,339.6,
ZZZHYDROCORTISONE 1% CREAM PACKET,7036132,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZBACTROBAN (MUPIROCIN) 2% CREAM,7036155,CDM,250,RC,,,Outpatient,,,1232,616,,330.92,26.86,,,percent of total billed charges,26.86% of total billed charges,924,75,,,percent of total billed charges,75% of total billed charges ,924,75,,,percent of total billed charges,75% of total billed charges ,295.68,24,,,percent of total billed charges,24% of total billed charges ,924,75,,,percent of total billed charges,75% of total billed charges ,924,75,,,percent of total billed charges,75% of total billed charges ,985.6,80,,,percent of total billed charges,80% of total billed charges ,298.64,24.24,,,percent of total billed charges,24.24% of total billed charges ,620.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,924,75,,,percent of total billed charges,75% of total billed charges ,301.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,330.92,26.86,,,percent of total billed charges,26.86% of total billed charges,295.68,24,,,percent of total billed charges,24% of total billed charges ,384.38,31.2,,,percent of total billed charges,31.2% of total billed charges,985.6,80,,,percent of total billed charges,80% of total billed charges,295.68,24,,,percent of total billed charges,24% of total billed charges ,295.68,24,,,percent of total billed charges,24% of total billed charges ,295.68,985.6,
DIPROLENE (BETAM DIPROP) 0.05% CRM,7036163,CDM,250,RC,,,Outpatient,,,411,205.5,,110.39,26.86,,,percent of total billed charges,26.86% of total billed charges,308.25,75,,,percent of total billed charges,75% of total billed charges ,308.25,75,,,percent of total billed charges,75% of total billed charges ,98.64,24,,,percent of total billed charges,24% of total billed charges ,308.25,75,,,percent of total billed charges,75% of total billed charges ,308.25,75,,,percent of total billed charges,75% of total billed charges ,328.8,80,,,percent of total billed charges,80% of total billed charges ,99.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,207.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,308.25,75,,,percent of total billed charges,75% of total billed charges ,100.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,110.39,26.86,,,percent of total billed charges,26.86% of total billed charges,98.64,24,,,percent of total billed charges,24% of total billed charges ,128.23,31.2,,,percent of total billed charges,31.2% of total billed charges,328.8,80,,,percent of total billed charges,80% of total billed charges,98.64,24,,,percent of total billed charges,24% of total billed charges ,98.64,24,,,percent of total billed charges,24% of total billed charges ,98.64,328.8,
SYNTHROID (LEVOTHYROXINE) 100MCG TB,7036170,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
DIPROLENE (BETAM DIPROP) 0.05% OINT,7036174,CDM,250,RC,,,Outpatient,,,315,157.5,,84.61,26.86,,,percent of total billed charges,26.86% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges ,236.25,75,,,percent of total billed charges,75% of total billed charges ,75.6,24,,,percent of total billed charges,24% of total billed charges ,236.25,75,,,percent of total billed charges,75% of total billed charges ,236.25,75,,,percent of total billed charges,75% of total billed charges ,252,80,,,percent of total billed charges,80% of total billed charges ,76.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,158.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,236.25,75,,,percent of total billed charges,75% of total billed charges ,77.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,84.61,26.86,,,percent of total billed charges,26.86% of total billed charges,75.6,24,,,percent of total billed charges,24% of total billed charges ,98.28,31.2,,,percent of total billed charges,31.2% of total billed charges,252,80,,,percent of total billed charges,80% of total billed charges,75.6,24,,,percent of total billed charges,24% of total billed charges ,75.6,24,,,percent of total billed charges,24% of total billed charges ,75.6,252,
ZZZELOCON (MOMETASONE) 0.1% CREAM 15GM,7036176,CDM,250,RC,,,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
ZZZELOCON (MOMETASONE FUR) 0.1% OINT,7036178,CDM,250,RC,,,Outpatient,,,85.5,42.75,,22.97,26.86,,,percent of total billed charges,26.86% of total billed charges,64.13,75,,,percent of total billed charges,75% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,20.52,24,,,percent of total billed charges,24% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,68.4,80,,,percent of total billed charges,80% of total billed charges ,20.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,43.09,50.4,,,percent of total billed charges,50.4% of total billed charges ,64.13,75,,,percent of total billed charges,75% of total billed charges ,20.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.97,26.86,,,percent of total billed charges,26.86% of total billed charges,20.52,24,,,percent of total billed charges,24% of total billed charges ,26.68,31.2,,,percent of total billed charges,31.2% of total billed charges,68.4,80,,,percent of total billed charges,80% of total billed charges,20.52,24,,,percent of total billed charges,24% of total billed charges ,20.52,24,,,percent of total billed charges,24% of total billed charges ,20.52,68.4,
ZZZGENTAMYCIN 0.3% OPTH OINT 3.5GM,7036182,CDM,250,RC,,,Outpatient,,,106,53,,28.47,26.86,,,percent of total billed charges,26.86% of total billed charges,79.5,75,,,percent of total billed charges,75% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,25.44,24,,,percent of total billed charges,24% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,84.8,80,,,percent of total billed charges,80% of total billed charges ,25.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,53.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,79.5,75,,,percent of total billed charges,75% of total billed charges ,25.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.47,26.86,,,percent of total billed charges,26.86% of total billed charges,25.44,24,,,percent of total billed charges,24% of total billed charges ,33.07,31.2,,,percent of total billed charges,31.2% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,25.44,24,,,percent of total billed charges,24% of total billed charges ,25.44,24,,,percent of total billed charges,24% of total billed charges ,25.44,84.8,
ZZZSYNALAR (FLUOCINONIDE ) 0.05% OINT,7036230,CDM,250,RC,,,Outpatient,,,350,175,,94.01,26.86,,,percent of total billed charges,26.86% of total billed charges,262.5,75,,,percent of total billed charges,75% of total billed charges ,262.5,75,,,percent of total billed charges,75% of total billed charges ,84,24,,,percent of total billed charges,24% of total billed charges ,262.5,75,,,percent of total billed charges,75% of total billed charges ,262.5,75,,,percent of total billed charges,75% of total billed charges ,280,80,,,percent of total billed charges,80% of total billed charges ,84.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,176.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,262.5,75,,,percent of total billed charges,75% of total billed charges ,85.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,94.01,26.86,,,percent of total billed charges,26.86% of total billed charges,84,24,,,percent of total billed charges,24% of total billed charges ,109.2,31.2,,,percent of total billed charges,31.2% of total billed charges,280,80,,,percent of total billed charges,80% of total billed charges,84,24,,,percent of total billed charges,24% of total billed charges ,84,24,,,percent of total billed charges,24% of total billed charges ,84,280,
LOTRIMIN (CLOTRIMAZOLE) 1% 15GM CRM,7036260,CDM,250,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
MASTISOL (MASTIC/STORAX/MSAL) 2/3ML,7036262,CDM,250,RC,,,Outpatient,,,26,13,,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,20.8,
LOTRISONE (CLOTRIMAZOLE/BETAM) CRM,7036270,CDM,250,RC,,,Outpatient,,,175,87.5,,47.01,26.86,,,percent of total billed charges,26.86% of total billed charges,131.25,75,,,percent of total billed charges,75% of total billed charges ,131.25,75,,,percent of total billed charges,75% of total billed charges ,42,24,,,percent of total billed charges,24% of total billed charges ,131.25,75,,,percent of total billed charges,75% of total billed charges ,131.25,75,,,percent of total billed charges,75% of total billed charges ,140,80,,,percent of total billed charges,80% of total billed charges ,42.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,88.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,131.25,75,,,percent of total billed charges,75% of total billed charges ,42.84,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.01,26.86,,,percent of total billed charges,26.86% of total billed charges,42,24,,,percent of total billed charges,24% of total billed charges ,54.6,31.2,,,percent of total billed charges,31.2% of total billed charges,140,80,,,percent of total billed charges,80% of total billed charges,42,24,,,percent of total billed charges,24% of total billed charges ,42,24,,,percent of total billed charges,24% of total billed charges ,42,140,
MOISTURE BARRIER OINTMENT TOPICAL,7036275,CDM,250,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
NITRO-BID (NITROGLYCERIN) 2% OIN PKT,7036300,CDM,250,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
NYSTATIN POWDER 15GM BOTTLE,7036325,CDM,250,RC,,,Outpatient,,,180,90,,48.35,26.86,,,percent of total billed charges,26.86% of total billed charges,135,75,,,percent of total billed charges,75% of total billed charges ,135,75,,,percent of total billed charges,75% of total billed charges ,43.2,24,,,percent of total billed charges,24% of total billed charges ,135,75,,,percent of total billed charges,75% of total billed charges ,135,75,,,percent of total billed charges,75% of total billed charges ,144,80,,,percent of total billed charges,80% of total billed charges ,43.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,90.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,135,75,,,percent of total billed charges,75% of total billed charges ,44.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,48.35,26.86,,,percent of total billed charges,26.86% of total billed charges,43.2,24,,,percent of total billed charges,24% of total billed charges ,56.16,31.2,,,percent of total billed charges,31.2% of total billed charges,144,80,,,percent of total billed charges,80% of total billed charges,43.2,24,,,percent of total billed charges,24% of total billed charges ,43.2,24,,,percent of total billed charges,24% of total billed charges ,43.2,144,
MYCOLOG (NYSTATIN/TRIAMCIN) CRM,7036333,CDM,250,RC,,,Outpatient,,,128,64,,34.38,26.86,,,percent of total billed charges,26.86% of total billed charges,96,75,,,percent of total billed charges,75% of total billed charges ,96,75,,,percent of total billed charges,75% of total billed charges ,30.72,24,,,percent of total billed charges,24% of total billed charges ,96,75,,,percent of total billed charges,75% of total billed charges ,96,75,,,percent of total billed charges,75% of total billed charges ,102.4,80,,,percent of total billed charges,80% of total billed charges ,31.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,64.51,50.4,,,percent of total billed charges,50.4% of total billed charges ,96,75,,,percent of total billed charges,75% of total billed charges ,31.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,34.38,26.86,,,percent of total billed charges,26.86% of total billed charges,30.72,24,,,percent of total billed charges,24% of total billed charges ,39.94,31.2,,,percent of total billed charges,31.2% of total billed charges,102.4,80,,,percent of total billed charges,80% of total billed charges,30.72,24,,,percent of total billed charges,24% of total billed charges ,30.72,24,,,percent of total billed charges,24% of total billed charges ,30.72,102.4,
ZZZMETRONIDAZOLE VAG 0.75% 70GM GEL,7036353,CDM,250,RC,,,Outpatient,,,646,323,,173.52,26.86,,,percent of total billed charges,26.86% of total billed charges,484.5,75,,,percent of total billed charges,75% of total billed charges ,484.5,75,,,percent of total billed charges,75% of total billed charges ,155.04,24,,,percent of total billed charges,24% of total billed charges ,484.5,75,,,percent of total billed charges,75% of total billed charges ,484.5,75,,,percent of total billed charges,75% of total billed charges ,516.8,80,,,percent of total billed charges,80% of total billed charges ,156.59,24.24,,,percent of total billed charges,24.24% of total billed charges ,325.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,484.5,75,,,percent of total billed charges,75% of total billed charges ,158.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,173.52,26.86,,,percent of total billed charges,26.86% of total billed charges,155.04,24,,,percent of total billed charges,24% of total billed charges ,201.55,31.2,,,percent of total billed charges,31.2% of total billed charges,516.8,80,,,percent of total billed charges,80% of total billed charges,155.04,24,,,percent of total billed charges,24% of total billed charges ,155.04,24,,,percent of total billed charges,24% of total billed charges ,155.04,516.8,
"NYSTATIN 100,000UNIT/GM OINT 15GM",7036354,CDM,250,RC,,,Outpatient,,,96,48,,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,76.8,
ZZZMICONAZOLE 2% VAGINAL CREAM 1.5OZ,7036370,CDM,250,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
NIZORAL (KETOCONAZOLE 2%) CREAM,7036377,CDM,250,RC,,,Outpatient,,,558.5,279.25,,150.01,26.86,,,percent of total billed charges,26.86% of total billed charges,418.88,75,,,percent of total billed charges,75% of total billed charges ,418.88,75,,,percent of total billed charges,75% of total billed charges ,134.04,24,,,percent of total billed charges,24% of total billed charges ,418.88,75,,,percent of total billed charges,75% of total billed charges ,418.88,75,,,percent of total billed charges,75% of total billed charges ,446.8,80,,,percent of total billed charges,80% of total billed charges ,135.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,281.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,418.88,75,,,percent of total billed charges,75% of total billed charges ,136.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,150.01,26.86,,,percent of total billed charges,26.86% of total billed charges,134.04,24,,,percent of total billed charges,24% of total billed charges ,174.25,31.2,,,percent of total billed charges,31.2% of total billed charges,446.8,80,,,percent of total billed charges,80% of total billed charges,134.04,24,,,percent of total billed charges,24% of total billed charges ,134.04,24,,,percent of total billed charges,24% of total billed charges ,134.04,446.8,
"NYSTATIN 100,000UNIT/GM CRM 15GM",7036383,CDM,250,RC,,,Outpatient,,,96,48,,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,76.8,
POLYSPORIN (BACIT/POLYMIXIN) OIN PKT,7036394,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZSILVADENE (SILVER SULFA) 1% 400GM,7036410,CDM,250,RC,,,Outpatient,,,322.5,161.25,,86.62,26.86,,,percent of total billed charges,26.86% of total billed charges,241.88,75,,,percent of total billed charges,75% of total billed charges ,241.88,75,,,percent of total billed charges,75% of total billed charges ,77.4,24,,,percent of total billed charges,24% of total billed charges ,241.88,75,,,percent of total billed charges,75% of total billed charges ,241.88,75,,,percent of total billed charges,75% of total billed charges ,258,80,,,percent of total billed charges,80% of total billed charges ,78.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,162.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,241.88,75,,,percent of total billed charges,75% of total billed charges ,78.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,86.62,26.86,,,percent of total billed charges,26.86% of total billed charges,77.4,24,,,percent of total billed charges,24% of total billed charges ,100.62,31.2,,,percent of total billed charges,31.2% of total billed charges,258,80,,,percent of total billed charges,80% of total billed charges,77.4,24,,,percent of total billed charges,24% of total billed charges ,77.4,24,,,percent of total billed charges,24% of total billed charges ,77.4,258,
ZZZSILVADENE (SILVER SULFA) 1% 50GM,7036420,CDM,250,RC,,,Outpatient,,,315,157.5,,84.61,26.86,,,percent of total billed charges,26.86% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges ,236.25,75,,,percent of total billed charges,75% of total billed charges ,75.6,24,,,percent of total billed charges,24% of total billed charges ,236.25,75,,,percent of total billed charges,75% of total billed charges ,236.25,75,,,percent of total billed charges,75% of total billed charges ,252,80,,,percent of total billed charges,80% of total billed charges ,76.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,158.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,236.25,75,,,percent of total billed charges,75% of total billed charges ,77.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,84.61,26.86,,,percent of total billed charges,26.86% of total billed charges,75.6,24,,,percent of total billed charges,24% of total billed charges ,98.28,31.2,,,percent of total billed charges,31.2% of total billed charges,252,80,,,percent of total billed charges,80% of total billed charges,75.6,24,,,percent of total billed charges,24% of total billed charges ,75.6,24,,,percent of total billed charges,24% of total billed charges ,75.6,252,
SILVADENE (SILVER SULFA) 1% 20GM,7036430,CDM,250,RC,,,Outpatient,,,101,50.5,,27.13,26.86,,,percent of total billed charges,26.86% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.13,26.86,,,percent of total billed charges,26.86% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,80.8,
SILVER NITRATE APPLICATOR,7036460,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
TOPICORT (DESOXIMETA) 0.05% GEL 15GM,7036470,CDM,250,RC,,,Outpatient,,,450,225,,120.87,26.86,,,percent of total billed charges,26.86% of total billed charges,337.5,75,,,percent of total billed charges,75% of total billed charges ,337.5,75,,,percent of total billed charges,75% of total billed charges ,108,24,,,percent of total billed charges,24% of total billed charges ,337.5,75,,,percent of total billed charges,75% of total billed charges ,337.5,75,,,percent of total billed charges,75% of total billed charges ,360,80,,,percent of total billed charges,80% of total billed charges ,109.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,226.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,337.5,75,,,percent of total billed charges,75% of total billed charges ,110.16,24.48,,,percent of total billed charges,24.48% of total billed charges ,120.87,26.86,,,percent of total billed charges,26.86% of total billed charges,108,24,,,percent of total billed charges,24% of total billed charges ,140.4,31.2,,,percent of total billed charges,31.2% of total billed charges,360,80,,,percent of total billed charges,80% of total billed charges,108,24,,,percent of total billed charges,24% of total billed charges ,108,24,,,percent of total billed charges,24% of total billed charges ,108,360,
TOBRADEX (TOBRAM/DEX) OPTH OINT 3.5G,7036472,CDM,250,RC,,,Outpatient,,,1179.5,589.75,,316.81,26.86,,,percent of total billed charges,26.86% of total billed charges,884.63,75,,,percent of total billed charges,75% of total billed charges ,884.63,75,,,percent of total billed charges,75% of total billed charges ,283.08,24,,,percent of total billed charges,24% of total billed charges ,884.63,75,,,percent of total billed charges,75% of total billed charges ,884.63,75,,,percent of total billed charges,75% of total billed charges ,943.6,80,,,percent of total billed charges,80% of total billed charges ,285.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,594.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,884.63,75,,,percent of total billed charges,75% of total billed charges ,288.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,316.81,26.86,,,percent of total billed charges,26.86% of total billed charges,283.08,24,,,percent of total billed charges,24% of total billed charges ,368,31.2,,,percent of total billed charges,31.2% of total billed charges,943.6,80,,,percent of total billed charges,80% of total billed charges,283.08,24,,,percent of total billed charges,24% of total billed charges ,283.08,24,,,percent of total billed charges,24% of total billed charges ,283.08,943.6,
ZZZTOPICORT (DESOXIMETA) 0.25% CRM 15GM,7036480,CDM,250,RC,,,Outpatient,,,290.5,145.25,,78.03,26.86,,,percent of total billed charges,26.86% of total billed charges,217.88,75,,,percent of total billed charges,75% of total billed charges ,217.88,75,,,percent of total billed charges,75% of total billed charges ,69.72,24,,,percent of total billed charges,24% of total billed charges ,217.88,75,,,percent of total billed charges,75% of total billed charges ,217.88,75,,,percent of total billed charges,75% of total billed charges ,232.4,80,,,percent of total billed charges,80% of total billed charges ,70.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,146.41,50.4,,,percent of total billed charges,50.4% of total billed charges ,217.88,75,,,percent of total billed charges,75% of total billed charges ,71.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,78.03,26.86,,,percent of total billed charges,26.86% of total billed charges,69.72,24,,,percent of total billed charges,24% of total billed charges ,90.64,31.2,,,percent of total billed charges,31.2% of total billed charges,232.4,80,,,percent of total billed charges,80% of total billed charges,69.72,24,,,percent of total billed charges,24% of total billed charges ,69.72,24,,,percent of total billed charges,24% of total billed charges ,69.72,232.4,
NEXTERONE (AMIODARONE) 360MG/200MLIV,7036485,CDM,636,RC,J0282,HCPCS,Outpatient,,,267,133.5,,71.72,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,64.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,213.6,80,,,percent of total billed charges,80% of total billed charges ,64.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,134.57,50.4,,,percent of total billed charges,50.4% of total billed charges ,200.25,75,,,percent of total billed charges,75% of total billed charges ,65.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,71.72,26.86,,,percent of total billed charges,26.86% of total billed charges,64.08,24,,,percent of total billed charges,24% of total billed charges ,83.3,31.2,,,percent of total billed charges,31.2% of total billed charges,213.6,80,,,percent of total billed charges,80% of total billed charges,64.08,24,,,percent of total billed charges,24% of total billed charges ,64.08,24,,,percent of total billed charges,24% of total billed charges ,64.08,213.6,
ZZZLIDOCAINE & PRILOCAINE CR 2.5%/2.5%,7036505,CDM,250,RC,,,Outpatient,,,265.5,132.75,,71.31,26.86,,,percent of total billed charges,26.86% of total billed charges,199.13,75,,,percent of total billed charges,75% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,63.72,24,,,percent of total billed charges,24% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,212.4,80,,,percent of total billed charges,80% of total billed charges ,64.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,133.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,199.13,75,,,percent of total billed charges,75% of total billed charges ,64.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,71.31,26.86,,,percent of total billed charges,26.86% of total billed charges,63.72,24,,,percent of total billed charges,24% of total billed charges ,82.84,31.2,,,percent of total billed charges,31.2% of total billed charges,212.4,80,,,percent of total billed charges,80% of total billed charges,63.72,24,,,percent of total billed charges,24% of total billed charges ,63.72,24,,,percent of total billed charges,24% of total billed charges ,63.72,212.4,
LIDOCAINE 5% TOPICAL OINTMENT,7036511,CDM,250,RC,,,Outpatient,,,404,202,,108.51,26.86,,,percent of total billed charges,26.86% of total billed charges,303,75,,,percent of total billed charges,75% of total billed charges ,303,75,,,percent of total billed charges,75% of total billed charges ,96.96,24,,,percent of total billed charges,24% of total billed charges ,303,75,,,percent of total billed charges,75% of total billed charges ,303,75,,,percent of total billed charges,75% of total billed charges ,323.2,80,,,percent of total billed charges,80% of total billed charges ,97.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,203.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,303,75,,,percent of total billed charges,75% of total billed charges ,98.9,24.48,,,percent of total billed charges,24.48% of total billed charges ,108.51,26.86,,,percent of total billed charges,26.86% of total billed charges,96.96,24,,,percent of total billed charges,24% of total billed charges ,126.05,31.2,,,percent of total billed charges,31.2% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,96.96,24,,,percent of total billed charges,24% of total billed charges ,96.96,24,,,percent of total billed charges,24% of total billed charges ,96.96,323.2,
NEXTERONE (AMIODARONE) 150MG/100ML IV,7036590,CDM,636,RC,J0282,HCPCS,Outpatient,,,211,105.5,,56.67,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,50.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,168.8,80,,,percent of total billed charges,80% of total billed charges ,51.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,106.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,158.25,75,,,percent of total billed charges,75% of total billed charges ,51.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,56.67,26.86,,,percent of total billed charges,26.86% of total billed charges,50.64,24,,,percent of total billed charges,24% of total billed charges ,65.83,31.2,,,percent of total billed charges,31.2% of total billed charges,168.8,80,,,percent of total billed charges,80% of total billed charges,50.64,24,,,percent of total billed charges,24% of total billed charges ,50.64,24,,,percent of total billed charges,24% of total billed charges ,50.64,168.8,
HIBICLENS 4%(CHLORHEXIDINE) 4OZ LIQ,7036600,CDM,250,RC,,,Outpatient,,,29,14.5,,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,23.2,80,,,percent of total billed charges,80% of total billed charges ,7.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,7.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,9.05,31.2,,,percent of total billed charges,31.2% of total billed charges,23.2,80,,,percent of total billed charges,80% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,23.2,
BETADINE (POVIDONE-IODINE) 10% SOLN,7036620,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ZZZCALAMINE LOTION 177ML,7036680,CDM,250,RC,,,Outpatient,,,13.5,6.75,,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,10.8,80,,,percent of total billed charges,80% of total billed charges ,3.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,6.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.13,75,,,percent of total billed charges,75% of total billed charges ,3.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.63,26.86,,,percent of total billed charges,26.86% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,4.21,31.2,,,percent of total billed charges,31.2% of total billed charges,10.8,80,,,percent of total billed charges,80% of total billed charges,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,24,,,percent of total billed charges,24% of total billed charges ,3.24,10.8,
INFED (IRON DEXTRAN) 100MG/2ML VIAL,7036695,CDM,636,RC,J1750,HCPCS,Outpatient,,,205,102.5,,17.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,164,80,,,percent of total billed charges,80% of total billed charges ,49.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,103.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,153.75,75,,,percent of total billed charges,75% of total billed charges ,50.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,49.2,24,,,percent of total billed charges,24% of total billed charges ,63.96,31.2,,,percent of total billed charges,31.2% of total billed charges,164,80,,,percent of total billed charges,80% of total billed charges,49.2,24,,,percent of total billed charges,24% of total billed charges ,49.2,24,,,percent of total billed charges,24% of total billed charges ,17.32,164,
ZZZGRANULEX (TRYPSIN/BALSAM) SPRAY,7036710,CDM,250,RC,,,Outpatient,,,56.5,28.25,,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
VOLTAREN (DICLOFENAC SOD) 50MG TAB,7036905,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
BYSTOLIC (NEBIVOLOL) 5MG TAB,7037010,CDM,250,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
OXYCODONE HCL 20MG TAB,7037220,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
"ZZZFLUOROMETHOLONE 0.1 % EYE DROPS,SUSP",7037325,CDM,250,RC,,,Outpatient,,,390.5,195.25,,104.89,26.86,,,percent of total billed charges,26.86% of total billed charges,292.88,75,,,percent of total billed charges,75% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,93.72,24,,,percent of total billed charges,24% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,312.4,80,,,percent of total billed charges,80% of total billed charges ,94.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,196.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,95.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,104.89,26.86,,,percent of total billed charges,26.86% of total billed charges,93.72,24,,,percent of total billed charges,24% of total billed charges ,121.84,31.2,,,percent of total billed charges,31.2% of total billed charges,312.4,80,,,percent of total billed charges,80% of total billed charges,93.72,24,,,percent of total billed charges,24% of total billed charges ,93.72,24,,,percent of total billed charges,24% of total billed charges ,93.72,312.4,
ZZZPRADAXA (DABIGATRAN ETEX) 150MG CAP,7037430,CDM,250,RC,,,Outpatient,,,40,20,,10.74,26.86,,,percent of total billed charges,26.86% of total billed charges,30,75,,,percent of total billed charges,75% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,9.6,24,,,percent of total billed charges,24% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,32,80,,,percent of total billed charges,80% of total billed charges ,9.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,9.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.74,26.86,,,percent of total billed charges,26.86% of total billed charges,9.6,24,,,percent of total billed charges,24% of total billed charges ,12.48,31.2,,,percent of total billed charges,31.2% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,9.6,24,,,percent of total billed charges,24% of total billed charges ,9.6,24,,,percent of total billed charges,24% of total billed charges ,9.6,32,
ENSURE CLEAR 296ML BOTTLE,7037640,CDM,270,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
MERREM (MEROPENEM) 500MG INJ,7037745,CDM,636,RC,J2185,HCPCS,Outpatient,,,155.5,77.75,,0.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,37.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,124.4,80,,,percent of total billed charges,80% of total billed charges ,37.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,78.37,50.4,,,percent of total billed charges,50.4% of total billed charges ,116.63,75,,,percent of total billed charges,75% of total billed charges ,38.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,37.32,24,,,percent of total billed charges,24% of total billed charges ,48.52,31.2,,,percent of total billed charges,31.2% of total billed charges,124.4,80,,,percent of total billed charges,80% of total billed charges,37.32,24,,,percent of total billed charges,24% of total billed charges ,37.32,24,,,percent of total billed charges,24% of total billed charges ,0.45,124.4,
CEPACOL (BENZ/MENTH) 15MG/10MG LOZ,7037955,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
INVANZ (ERTAPENEM SOD) 1GM INJ,7038060,CDM,636,RC,J1335,HCPCS,Outpatient,,,595.5,297.75,,12.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,142.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,476.4,80,,,percent of total billed charges,80% of total billed charges ,144.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,300.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,446.63,75,,,percent of total billed charges,75% of total billed charges ,145.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,142.92,24,,,percent of total billed charges,24% of total billed charges ,185.8,31.2,,,percent of total billed charges,31.2% of total billed charges,476.4,80,,,percent of total billed charges,80% of total billed charges,142.92,24,,,percent of total billed charges,24% of total billed charges ,142.92,24,,,percent of total billed charges,24% of total billed charges ,12.97,476.4,
NORCO (HYDROCODONE/APAP) 5/325MG TAB,7038270,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
NORCO (HYDROCODONE/APAP) 7.5/325MG TAB,7038375,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
NORCO (HYDROCODONE/APAP) 10/325MG TAB,7038480,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ZZZENSURE COMPLETE 237ML BOTTLE,7038690,CDM,272,RC,,,Outpatient,,,22.5,11.25,,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,18,
PREDNISONE 1MG TAB,7038795,CDM,250,RC,J7512,HCPCS,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
UNNA-FLEX ELASTIC UNNA BOOT 4 X10,7038900,CDM,270,RC,,,Outpatient,,,690,345,,185.33,26.86,,,percent of total billed charges,26.86% of total billed charges,517.5,75,,,percent of total billed charges,75% of total billed charges ,517.5,75,,,percent of total billed charges,75% of total billed charges ,165.6,24,,,percent of total billed charges,24% of total billed charges ,517.5,75,,,percent of total billed charges,75% of total billed charges ,517.5,75,,,percent of total billed charges,75% of total billed charges ,552,80,,,percent of total billed charges,80% of total billed charges ,167.26,24.24,,,percent of total billed charges,24.24% of total billed charges ,347.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,517.5,75,,,percent of total billed charges,75% of total billed charges ,168.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,185.33,26.86,,,percent of total billed charges,26.86% of total billed charges,165.6,24,,,percent of total billed charges,24% of total billed charges ,215.28,31.2,,,percent of total billed charges,31.2% of total billed charges,552,80,,,percent of total billed charges,80% of total billed charges,165.6,24,,,percent of total billed charges,24% of total billed charges ,165.6,24,,,percent of total billed charges,24% of total billed charges ,165.6,552,
ZZZPROLIXIN (FLUPHENAZINE) 5MG TAB,7039005,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZYVOX (LINEZOLID) 600MG/300ML IVPB,7039215,CDM,636,RC,J2020,HCPCS,Outpatient,,,442,221,,3.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,106.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,353.6,80,,,percent of total billed charges,80% of total billed charges ,107.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,222.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,331.5,75,,,percent of total billed charges,75% of total billed charges ,108.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,106.08,24,,,percent of total billed charges,24% of total billed charges ,137.9,31.2,,,percent of total billed charges,31.2% of total billed charges,353.6,80,,,percent of total billed charges,80% of total billed charges,106.08,24,,,percent of total billed charges,24% of total billed charges ,106.08,24,,,percent of total billed charges,24% of total billed charges ,3.3,353.6,
BLOOD GLUCOSE TEST STRIPS,7039425,CDM,272,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZOSYN (PIPERACILLIN/TAZ) 2.25GM INJ,7039635,CDM,636,RC,J2543,HCPCS,Outpatient,,,81.5,40.75,,1.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,65.2,80,,,percent of total billed charges,80% of total billed charges ,19.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.13,75,,,percent of total billed charges,75% of total billed charges ,19.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,19.56,24,,,percent of total billed charges,24% of total billed charges ,25.43,31.2,,,percent of total billed charges,31.2% of total billed charges,65.2,80,,,percent of total billed charges,80% of total billed charges,19.56,24,,,percent of total billed charges,24% of total billed charges ,19.56,24,,,percent of total billed charges,24% of total billed charges ,1.18,65.2,
SINGULAIR (MONTELUKAST) 10MG TAB,7039844,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZHALDOL (HALOPERIDOL) 0.5MG TAB,7039845,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
INSULIN-LONG ACTING (LANTUS) PEN,7039896,CDM,250,RC,,,Outpatient,,,120,60,,32.23,26.86,,,percent of total billed charges,26.86% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges ,90,75,,,percent of total billed charges,75% of total billed charges ,28.8,24,,,percent of total billed charges,24% of total billed charges ,90,75,,,percent of total billed charges,75% of total billed charges ,90,75,,,percent of total billed charges,75% of total billed charges ,96,80,,,percent of total billed charges,80% of total billed charges ,29.09,24.24,,,percent of total billed charges,24.24% of total billed charges ,60.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,90,75,,,percent of total billed charges,75% of total billed charges ,29.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.23,26.86,,,percent of total billed charges,26.86% of total billed charges,28.8,24,,,percent of total billed charges,24% of total billed charges ,37.44,31.2,,,percent of total billed charges,31.2% of total billed charges,96,80,,,percent of total billed charges,80% of total billed charges,28.8,24,,,percent of total billed charges,24% of total billed charges ,28.8,24,,,percent of total billed charges,24% of total billed charges ,28.8,96,
K-LOR (POTASSIUM CL) 10MEQ TAB,7039898,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
ZZZWELLBUTRIN SR (BUPROPION) 100MG TAB,7039949,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZOSYN (PIPERACILLIN-TAZ) 3.375GM INJ,7040001,CDM,636,RC,J2543,HCPCS,Outpatient,,,116.5,58.25,,1.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,93.2,80,,,percent of total billed charges,80% of total billed charges ,28.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,58.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,87.38,75,,,percent of total billed charges,75% of total billed charges ,28.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.96,24,,,percent of total billed charges,24% of total billed charges ,36.35,31.2,,,percent of total billed charges,31.2% of total billed charges,93.2,80,,,percent of total billed charges,80% of total billed charges,27.96,24,,,percent of total billed charges,24% of total billed charges ,27.96,24,,,percent of total billed charges,24% of total billed charges ,1.18,93.2,
HEPARIN FLUSH 100 UNIT/ML 5ML SYR,7040054,CDM,636,RC,J1642,HCPCS,Outpatient,,,25,12.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20,80,,,percent of total billed charges,80% of total billed charges ,6.06,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.6,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.75,75,,,percent of total billed charges,75% of total billed charges ,6.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,,,,,Other,Not Separately reimbursable,6,24,,,percent of total billed charges,24% of total billed charges ,7.8,31.2,,,percent of total billed charges,31.2% of total billed charges,20,80,,,percent of total billed charges,80% of total billed charges,6,24,,,percent of total billed charges,24% of total billed charges ,6,24,,,percent of total billed charges,24% of total billed charges ,6,20,
DIFLUCAN (FLUCONAZOLE) 400MG/200ML IV,7040159,CDM,636,RC,J1450,HCPCS,Outpatient,,,92.5,46.25,,2.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.2,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,74,80,,,percent of total billed charges,80% of total billed charges ,22.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,46.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,22.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.2,24,,,percent of total billed charges,24% of total billed charges ,28.86,31.2,,,percent of total billed charges,31.2% of total billed charges,74,80,,,percent of total billed charges,80% of total billed charges,22.2,24,,,percent of total billed charges,24% of total billed charges ,22.2,24,,,percent of total billed charges,24% of total billed charges ,2.8,74,
TYGACIL (TIGECYCLINE) 50MG VIAL,7040263,CDM,636,RC,J3243,HCPCS,Outpatient,,,784,392,,210.58,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,188.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,627.2,80,,,percent of total billed charges,80% of total billed charges ,190.04,24.24,,,percent of total billed charges,24.24% of total billed charges ,395.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,588,75,,,percent of total billed charges,75% of total billed charges ,191.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,210.58,26.86,,,percent of total billed charges,26.86% of total billed charges,188.16,24,,,percent of total billed charges,24% of total billed charges ,244.61,31.2,,,percent of total billed charges,31.2% of total billed charges,627.2,80,,,percent of total billed charges,80% of total billed charges,188.16,24,,,percent of total billed charges,24% of total billed charges ,188.16,24,,,percent of total billed charges,24% of total billed charges ,188.16,627.2,
ZZZOPANA ER (OXYMORPHONE) 10MG TAB,7040368,CDM,250,RC,,,Outpatient,,,23.5,11.75,,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,18.8,80,,,percent of total billed charges,80% of total billed charges ,5.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,7.33,31.2,,,percent of total billed charges,31.2% of total billed charges,18.8,80,,,percent of total billed charges,80% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,18.8,
DIFLUCAN (FLUCONAZOLE) 200MG/100ML IV,7040369,CDM,636,RC,J1450,HCPCS,Outpatient,,,64,32,,2.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,2.8,51.2,
ZZZOPANA ER (OXYMORPHONE) 40MG TAB,7040473,CDM,250,RC,,,Outpatient,,,56.5,28.25,,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,45.2,80,,,percent of total billed charges,80% of total billed charges ,13.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,42.38,75,,,percent of total billed charges,75% of total billed charges ,13.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.18,26.86,,,percent of total billed charges,26.86% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,17.63,31.2,,,percent of total billed charges,31.2% of total billed charges,45.2,80,,,percent of total billed charges,80% of total billed charges,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,24,,,percent of total billed charges,24% of total billed charges ,13.56,45.2,
ZZZZOSTAVAX (ZOSTER VACCINE) 0.65ML,7040578,CDM,250,RC,90736,HCPCS,Outpatient,,,1101,550.5,,295.73,26.86,,,percent of total billed charges,26.86% of total billed charges,825.75,75,,,percent of total billed charges,75% of total billed charges ,825.75,75,,,percent of total billed charges,75% of total billed charges ,264.24,24,,,percent of total billed charges,24% of total billed charges ,825.75,75,,,percent of total billed charges,75% of total billed charges ,825.75,75,,,percent of total billed charges,75% of total billed charges ,880.8,80,,,percent of total billed charges,80% of total billed charges ,266.88,24.24,,,percent of total billed charges,24.24% of total billed charges ,554.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,825.75,75,,,percent of total billed charges,75% of total billed charges ,269.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,295.73,26.86,,,percent of total billed charges,26.86% of total billed charges,264.24,24,,,percent of total billed charges,24% of total billed charges ,343.51,31.2,,,percent of total billed charges,31.2% of total billed charges,880.8,80,,,percent of total billed charges,80% of total billed charges,264.24,24,,,percent of total billed charges,24% of total billed charges ,264.24,24,,,percent of total billed charges,24% of total billed charges ,264.24,880.8,
LEVAQUIN (LEVOFLOXACIN) 500MG TAB,7040579,CDM,250,RC,,,Outpatient,,,92.5,46.25,,24.85,26.86,,,percent of total billed charges,26.86% of total billed charges,69.38,75,,,percent of total billed charges,75% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,22.2,24,,,percent of total billed charges,24% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,74,80,,,percent of total billed charges,80% of total billed charges ,22.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,46.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,22.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.85,26.86,,,percent of total billed charges,26.86% of total billed charges,22.2,24,,,percent of total billed charges,24% of total billed charges ,28.86,31.2,,,percent of total billed charges,31.2% of total billed charges,74,80,,,percent of total billed charges,80% of total billed charges,22.2,24,,,percent of total billed charges,24% of total billed charges ,22.2,24,,,percent of total billed charges,24% of total billed charges ,22.2,74,
MERREM (MEROPENEM) 1GM INJ,7040683,CDM,636,RC,J2185,HCPCS,Outpatient,,,173.25,86.63,,0.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,41.58,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,138.6,80,,,percent of total billed charges,80% of total billed charges ,42,24.24,,,percent of total billed charges,24.24% of total billed charges ,87.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,129.94,75,,,percent of total billed charges,75% of total billed charges ,42.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,41.58,24,,,percent of total billed charges,24% of total billed charges ,54.05,31.2,,,percent of total billed charges,31.2% of total billed charges,138.6,80,,,percent of total billed charges,80% of total billed charges,41.58,24,,,percent of total billed charges,24% of total billed charges ,41.58,24,,,percent of total billed charges,24% of total billed charges ,0.45,138.6,
LEVAQUIN (LEVOFLOXACIN) 750MG TAB,7040684,CDM,250,RC,,,Outpatient,,,132,66,,35.46,26.86,,,percent of total billed charges,26.86% of total billed charges,99,75,,,percent of total billed charges,75% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,31.68,24,,,percent of total billed charges,24% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,105.6,80,,,percent of total billed charges,80% of total billed charges ,32,24.24,,,percent of total billed charges,24.24% of total billed charges ,66.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,32.31,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.46,26.86,,,percent of total billed charges,26.86% of total billed charges,31.68,24,,,percent of total billed charges,24% of total billed charges ,41.18,31.2,,,percent of total billed charges,31.2% of total billed charges,105.6,80,,,percent of total billed charges,80% of total billed charges,31.68,24,,,percent of total billed charges,24% of total billed charges ,31.68,24,,,percent of total billed charges,24% of total billed charges ,31.68,105.6,
ZZZBREVITAL (METHOHEXITAL) 2.5GM/20ML,7040789,CDM,250,RC,,,Outpatient,,,1080.5,540.25,,290.22,26.86,,,percent of total billed charges,26.86% of total billed charges,810.38,75,,,percent of total billed charges,75% of total billed charges ,810.38,75,,,percent of total billed charges,75% of total billed charges ,259.32,24,,,percent of total billed charges,24% of total billed charges ,810.38,75,,,percent of total billed charges,75% of total billed charges ,810.38,75,,,percent of total billed charges,75% of total billed charges ,864.4,80,,,percent of total billed charges,80% of total billed charges ,261.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,544.57,50.4,,,percent of total billed charges,50.4% of total billed charges ,810.38,75,,,percent of total billed charges,75% of total billed charges ,264.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,290.22,26.86,,,percent of total billed charges,26.86% of total billed charges,259.32,24,,,percent of total billed charges,24% of total billed charges ,337.12,31.2,,,percent of total billed charges,31.2% of total billed charges,864.4,80,,,percent of total billed charges,80% of total billed charges,259.32,24,,,percent of total billed charges,24% of total billed charges ,259.32,24,,,percent of total billed charges,24% of total billed charges ,259.32,864.4,
ZITHROMAX (AZITHROM) 500MG INJECTIO,7040841,CDM,636,RC,J0456,HCPCS,Outpatient,,,64,32,,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,51.2,
ZZZMEDROL (METHYLPREDNISOLONE) 2MG TAB,7040893,CDM,250,RC,,,Outpatient,,,9.5,4.75,,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,7.6,80,,,percent of total billed charges,80% of total billed charges ,2.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,4.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.13,75,,,percent of total billed charges,75% of total billed charges ,2.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.55,26.86,,,percent of total billed charges,26.86% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.96,31.2,,,percent of total billed charges,31.2% of total billed charges,7.6,80,,,percent of total billed charges,80% of total billed charges,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,24,,,percent of total billed charges,24% of total billed charges ,2.28,7.6,
ZZZPROLIXIN (FLUPHENAZINE) 2.5MG/ML INJ,7040988,CDM,636,RC,J2680,HCPCS,Outpatient,,,909.5,454.75,,9.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,218.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,727.6,80,,,percent of total billed charges,80% of total billed charges ,220.46,24.24,,,percent of total billed charges,24.24% of total billed charges ,458.39,50.4,,,percent of total billed charges,50.4% of total billed charges ,682.13,75,,,percent of total billed charges,75% of total billed charges ,222.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,218.28,24,,,percent of total billed charges,24% of total billed charges ,283.76,31.2,,,percent of total billed charges,31.2% of total billed charges,727.6,80,,,percent of total billed charges,80% of total billed charges,218.28,24,,,percent of total billed charges,24% of total billed charges ,218.28,24,,,percent of total billed charges,24% of total billed charges ,9.15,727.6,
LOVENOX (ENOXAPARIN) 40MG/0.4ML SYRINGE,7040999,CDM,636,RC,J1650,HCPCS,Outpatient,,,59.5,29.75,,15.98,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.6,80,,,percent of total billed charges,80% of total billed charges ,14.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.63,75,,,percent of total billed charges,75% of total billed charges ,14.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.98,26.86,,,percent of total billed charges,26.86% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,18.56,31.2,,,percent of total billed charges,31.2% of total billed charges,47.6,80,,,percent of total billed charges,80% of total billed charges,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,24,,,percent of total billed charges,24% of total billed charges ,14.28,47.6,
NS (0.9% SOD CHLORIDE) 50ML MBP,7041051,CDM,636,RC,J7050,HCPCS,Outpatient,,,44.5,22.25,,0.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.6,80,,,percent of total billed charges,80% of total billed charges ,10.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,10.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.68,24,,,percent of total billed charges,24% of total billed charges ,13.88,31.2,,,percent of total billed charges,31.2% of total billed charges,35.6,80,,,percent of total billed charges,80% of total billed charges,10.68,24,,,percent of total billed charges,24% of total billed charges ,10.68,24,,,percent of total billed charges,24% of total billed charges ,0.67,35.6,
ZZZMESALAMINE 60ML ENEMA,7041103,CDM,250,RC,,,Outpatient,,,127.5,63.75,,34.25,26.86,,,percent of total billed charges,26.86% of total billed charges,95.63,75,,,percent of total billed charges,75% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,30.6,24,,,percent of total billed charges,24% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,102,80,,,percent of total billed charges,80% of total billed charges ,30.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,64.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,31.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,34.25,26.86,,,percent of total billed charges,26.86% of total billed charges,30.6,24,,,percent of total billed charges,24% of total billed charges ,39.78,31.2,,,percent of total billed charges,31.2% of total billed charges,102,80,,,percent of total billed charges,80% of total billed charges,30.6,24,,,percent of total billed charges,24% of total billed charges ,30.6,24,,,percent of total billed charges,24% of total billed charges ,30.6,102,
MULTIVITAMIN W/MINERALS TAB,7041104,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
NS (0.9% SOD CHLORIDE) 100ML MBP,7041156,CDM,636,RC,J7050,HCPCS,Outpatient,,,45,22.5,,0.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36,80,,,percent of total billed charges,80% of total billed charges ,10.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,33.75,75,,,percent of total billed charges,75% of total billed charges ,11.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.8,24,,,percent of total billed charges,24% of total billed charges ,14.04,31.2,,,percent of total billed charges,31.2% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,10.8,24,,,percent of total billed charges,24% of total billed charges ,10.8,24,,,percent of total billed charges,24% of total billed charges ,0.67,36,
ZZZZOVIRAX (ACYCLOVIR) 5% OINTMENT 30G,7041209,CDM,250,RC,,,Outpatient,,,2547,1273.5,,684.12,26.86,,,percent of total billed charges,26.86% of total billed charges,1910.25,75,,,percent of total billed charges,75% of total billed charges ,1910.25,75,,,percent of total billed charges,75% of total billed charges ,611.28,24,,,percent of total billed charges,24% of total billed charges ,1910.25,75,,,percent of total billed charges,75% of total billed charges ,1910.25,75,,,percent of total billed charges,75% of total billed charges ,2037.6,80,,,percent of total billed charges,80% of total billed charges ,617.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,1283.69,50.4,,,percent of total billed charges,50.4% of total billed charges ,1910.25,75,,,percent of total billed charges,75% of total billed charges ,623.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,684.12,26.86,,,percent of total billed charges,26.86% of total billed charges,611.28,24,,,percent of total billed charges,24% of total billed charges ,794.66,31.2,,,percent of total billed charges,31.2% of total billed charges,2037.6,80,,,percent of total billed charges,80% of total billed charges,611.28,24,,,percent of total billed charges,24% of total billed charges ,611.28,24,,,percent of total billed charges,24% of total billed charges ,611.28,2037.6,
ZZZSTELAZINE (TRIFLUOPERAZINE) 2MG TAB,7041314,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
DUONEB (IPRATR/ALBUT) 3ML UD NEB,7041366,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
BREVITAL (METHOHEXITAL) 500MG/50ML,7041628,CDM,250,RC,,,Outpatient,,,366.5,183.25,,98.44,26.86,,,percent of total billed charges,26.86% of total billed charges,274.88,75,,,percent of total billed charges,75% of total billed charges ,274.88,75,,,percent of total billed charges,75% of total billed charges ,87.96,24,,,percent of total billed charges,24% of total billed charges ,274.88,75,,,percent of total billed charges,75% of total billed charges ,274.88,75,,,percent of total billed charges,75% of total billed charges ,293.2,80,,,percent of total billed charges,80% of total billed charges ,88.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,184.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,274.88,75,,,percent of total billed charges,75% of total billed charges ,89.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,98.44,26.86,,,percent of total billed charges,26.86% of total billed charges,87.96,24,,,percent of total billed charges,24% of total billed charges ,114.35,31.2,,,percent of total billed charges,31.2% of total billed charges,293.2,80,,,percent of total billed charges,80% of total billed charges,87.96,24,,,percent of total billed charges,24% of total billed charges ,87.96,24,,,percent of total billed charges,24% of total billed charges ,87.96,293.2,
PLAVIX (CLOPIDOGREL) 75MG TAB,7041629,CDM,250,RC,,,Outpatient,,,28,14,,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,22.4,80,,,percent of total billed charges,80% of total billed charges ,6.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,8.74,31.2,,,percent of total billed charges,31.2% of total billed charges,22.4,80,,,percent of total billed charges,80% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,22.4,
OS-CAL D (CAL CARB VITD3) 600+400 TABLET,7041681,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZEXELON (RAVASTIGMINE) 4.6MG/24HR PTCH,7041838,CDM,250,RC,,,Outpatient,,,89.5,44.75,,24.04,26.86,,,percent of total billed charges,26.86% of total billed charges,67.13,75,,,percent of total billed charges,75% of total billed charges ,67.13,75,,,percent of total billed charges,75% of total billed charges ,21.48,24,,,percent of total billed charges,24% of total billed charges ,67.13,75,,,percent of total billed charges,75% of total billed charges ,67.13,75,,,percent of total billed charges,75% of total billed charges ,71.6,80,,,percent of total billed charges,80% of total billed charges ,21.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,45.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,67.13,75,,,percent of total billed charges,75% of total billed charges ,21.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.04,26.86,,,percent of total billed charges,26.86% of total billed charges,21.48,24,,,percent of total billed charges,24% of total billed charges ,27.92,31.2,,,percent of total billed charges,31.2% of total billed charges,71.6,80,,,percent of total billed charges,80% of total billed charges,21.48,24,,,percent of total billed charges,24% of total billed charges ,21.48,24,,,percent of total billed charges,24% of total billed charges ,21.48,71.6,
CLEOCIN (CLINDAMYCIN)300MG/50MLIV(PREMIX,7041839,CDM,250,RC,,,Outpatient,,,62,31,,16.65,26.86,,,percent of total billed charges,26.86% of total billed charges,46.5,75,,,percent of total billed charges,75% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,14.88,24,,,percent of total billed charges,24% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,49.6,80,,,percent of total billed charges,80% of total billed charges ,15.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,15.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.65,26.86,,,percent of total billed charges,26.86% of total billed charges,14.88,24,,,percent of total billed charges,24% of total billed charges ,19.34,31.2,,,percent of total billed charges,31.2% of total billed charges,49.6,80,,,percent of total billed charges,80% of total billed charges,14.88,24,,,percent of total billed charges,24% of total billed charges ,14.88,24,,,percent of total billed charges,24% of total billed charges ,14.88,49.6,
ZZZEXELON (RAVASTIGMINE) 9.5MG/24HR PTCH,7041943,CDM,250,RC,,,Outpatient,,,125.5,62.75,,33.71,26.86,,,percent of total billed charges,26.86% of total billed charges,94.13,75,,,percent of total billed charges,75% of total billed charges ,94.13,75,,,percent of total billed charges,75% of total billed charges ,30.12,24,,,percent of total billed charges,24% of total billed charges ,94.13,75,,,percent of total billed charges,75% of total billed charges ,94.13,75,,,percent of total billed charges,75% of total billed charges ,100.4,80,,,percent of total billed charges,80% of total billed charges ,30.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,63.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,94.13,75,,,percent of total billed charges,75% of total billed charges ,30.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,33.71,26.86,,,percent of total billed charges,26.86% of total billed charges,30.12,24,,,percent of total billed charges,24% of total billed charges ,39.16,31.2,,,percent of total billed charges,31.2% of total billed charges,100.4,80,,,percent of total billed charges,80% of total billed charges,30.12,24,,,percent of total billed charges,24% of total billed charges ,30.12,24,,,percent of total billed charges,24% of total billed charges ,30.12,100.4,
ZZZPRAVACHOL (PRAVASTATIN SOD) 40MG TAB,7041944,CDM,250,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
MULTIVITAMIN15ML LIQUID,7041996,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
AUGMENTIN (AMOX/CLAV) 400MG/5ML SUS,7042048,CDM,250,RC,,,Outpatient,,,180.5,90.25,,48.48,26.86,,,percent of total billed charges,26.86% of total billed charges,135.38,75,,,percent of total billed charges,75% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,43.32,24,,,percent of total billed charges,24% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,144.4,80,,,percent of total billed charges,80% of total billed charges ,43.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,90.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,44.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,48.48,26.86,,,percent of total billed charges,26.86% of total billed charges,43.32,24,,,percent of total billed charges,24% of total billed charges ,56.32,31.2,,,percent of total billed charges,31.2% of total billed charges,144.4,80,,,percent of total billed charges,80% of total billed charges,43.32,24,,,percent of total billed charges,24% of total billed charges ,43.32,24,,,percent of total billed charges,24% of total billed charges ,43.32,144.4,
KLONAPIN (CLONAZEPAM) 0.5MG TAB,7042153,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
MARCAINE (BUPIVACAINE) 0.5% 30ML INJ,7042206,CDM,250,RC,,,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
VITAMIN D2(ERGOCALCIFEROL) 50000UNIT CAP,7042258,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ASTELIN (AZELASTINE HCL) 0.1% NASAL,7042259,CDM,250,RC,,,Outpatient,,,454,227,,121.94,26.86,,,percent of total billed charges,26.86% of total billed charges,340.5,75,,,percent of total billed charges,75% of total billed charges ,340.5,75,,,percent of total billed charges,75% of total billed charges ,108.96,24,,,percent of total billed charges,24% of total billed charges ,340.5,75,,,percent of total billed charges,75% of total billed charges ,340.5,75,,,percent of total billed charges,75% of total billed charges ,363.2,80,,,percent of total billed charges,80% of total billed charges ,110.05,24.24,,,percent of total billed charges,24.24% of total billed charges ,228.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,340.5,75,,,percent of total billed charges,75% of total billed charges ,111.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,121.94,26.86,,,percent of total billed charges,26.86% of total billed charges,108.96,24,,,percent of total billed charges,24% of total billed charges ,141.65,31.2,,,percent of total billed charges,31.2% of total billed charges,363.2,80,,,percent of total billed charges,80% of total billed charges,108.96,24,,,percent of total billed charges,24% of total billed charges ,108.96,24,,,percent of total billed charges,24% of total billed charges ,108.96,363.2,
ZZZENSURE MUSCLE HEALTH 237ML BOTTLE,7042836,CDM,270,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
HYDROCORTISONE 2.5% OINT 20GM,7042994,CDM,250,RC,,,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
AMPICILLIN 500MG INJ,7043010,CDM,636,RC,J0290,HCPCS,Outpatient,,,34,17,,1.01,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.01,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,1.01,27.2,
AMPICILLIN 1GM INJ,7043021,CDM,636,RC,J0290,HCPCS,Outpatient,,,51.5,25.75,,1.01,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.01,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,1.01,41.2,
CLEOCIN (CLINDAMYCIN) 600MG/50ML(PREMIX),7043040,CDM,250,RC,,,Outpatient,,,84.5,42.25,,22.7,26.86,,,percent of total billed charges,26.86% of total billed charges,63.38,75,,,percent of total billed charges,75% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,20.28,24,,,percent of total billed charges,24% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,67.6,80,,,percent of total billed charges,80% of total billed charges ,20.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,20.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.7,26.86,,,percent of total billed charges,26.86% of total billed charges,20.28,24,,,percent of total billed charges,24% of total billed charges ,26.36,31.2,,,percent of total billed charges,31.2% of total billed charges,67.6,80,,,percent of total billed charges,80% of total billed charges,20.28,24,,,percent of total billed charges,24% of total billed charges ,20.28,24,,,percent of total billed charges,24% of total billed charges ,20.28,67.6,
ZZZFOSPHENYTOIN 500MG PE/10ML INJ SOLU,7043046,CDM,636,RC,Q2009,HCPCS,Outpatient,,,287.5,143.75,,77.22,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,69,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,230,80,,,percent of total billed charges,80% of total billed charges ,69.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,144.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,215.63,75,,,percent of total billed charges,75% of total billed charges ,70.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,77.22,26.86,,,percent of total billed charges,26.86% of total billed charges,69,24,,,percent of total billed charges,24% of total billed charges ,89.7,31.2,,,percent of total billed charges,31.2% of total billed charges,230,80,,,percent of total billed charges,80% of total billed charges,69,24,,,percent of total billed charges,24% of total billed charges ,69,24,,,percent of total billed charges,24% of total billed charges ,69,230,
AZACTAM (AZTREONAM) 1GM INJ,7043050,CDM,250,RC,,,Outpatient,,,178,89,,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,142.4,
ANCEF (CEFAZOLIN) 1GM INJ,7043060,CDM,636,RC,J0690,HCPCS,Outpatient,,,21.5,10.75,,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,0.76,17.2,
ANCEF (CEFAZOLIN) 500MG INJ,7043070,CDM,636,RC,J0690,HCPCS,Outpatient,,,32,16,,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,0.76,25.6,
CLEOCIN (CLINDAMYCIN) 900MG/50ML,7043090,CDM,250,RC,,,Outpatient,,,99,49.5,,26.59,26.86,,,percent of total billed charges,26.86% of total billed charges,74.25,75,,,percent of total billed charges,75% of total billed charges ,74.25,75,,,percent of total billed charges,75% of total billed charges ,23.76,24,,,percent of total billed charges,24% of total billed charges ,74.25,75,,,percent of total billed charges,75% of total billed charges ,74.25,75,,,percent of total billed charges,75% of total billed charges ,79.2,80,,,percent of total billed charges,80% of total billed charges ,24,24.24,,,percent of total billed charges,24.24% of total billed charges ,49.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,74.25,75,,,percent of total billed charges,75% of total billed charges ,24.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.59,26.86,,,percent of total billed charges,26.86% of total billed charges,23.76,24,,,percent of total billed charges,24% of total billed charges ,30.89,31.2,,,percent of total billed charges,31.2% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,23.76,24,,,percent of total billed charges,24% of total billed charges ,23.76,24,,,percent of total billed charges,24% of total billed charges ,23.76,79.2,
VITAMIN B-12 (CYANOCOB) 100MCG TAB,7043098,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
LIPITOR (ATORVASTATIN) 40MG TAB,7043099,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZDIGIFAB 40MG VIAL,7043151,CDM,636,RC,J1162,HCPCS,Outpatient,,,27062,13531,,7268.85,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6494.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21649.6,80,,,percent of total billed charges,80% of total billed charges ,6559.83,24.24,,,percent of total billed charges,24.24% of total billed charges ,13639.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,20296.5,75,,,percent of total billed charges,75% of total billed charges ,6624.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,7268.85,26.86,,,percent of total billed charges,26.86% of total billed charges,6494.88,24,,,percent of total billed charges,24% of total billed charges ,8443.34,31.2,,,percent of total billed charges,31.2% of total billed charges,21649.6,80,,,percent of total billed charges,80% of total billed charges,6494.88,24,,,percent of total billed charges,24% of total billed charges ,6494.88,24,,,percent of total billed charges,24% of total billed charges ,6494.88,21649.6,
ZZZCLAFORAN (CEFOTAXIME) 1GM INJ,7043170,CDM,636,RC,J0698,HCPCS,Outpatient,,,22.5,11.25,,9.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,18,
ZZZCLAFORAN (CEFOTAXIME) 2GM INJ,7043180,CDM,636,RC,J0698,HCPCS,Outpatient,,,40,20,,9.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32,80,,,percent of total billed charges,80% of total billed charges ,9.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,9.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.6,24,,,percent of total billed charges,24% of total billed charges ,12.48,31.2,,,percent of total billed charges,31.2% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,9.6,24,,,percent of total billed charges,24% of total billed charges ,9.6,24,,,percent of total billed charges,24% of total billed charges ,9.6,32,
FORTAZ (CEFTAZIDIME) 500MG INJECT,7043190,CDM,636,RC,J0713,HCPCS,Outpatient,,,49.5,24.75,,1.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.6,80,,,percent of total billed charges,80% of total billed charges ,12,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,12.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.88,24,,,percent of total billed charges,24% of total billed charges ,15.44,31.2,,,percent of total billed charges,31.2% of total billed charges,39.6,80,,,percent of total billed charges,80% of total billed charges,11.88,24,,,percent of total billed charges,24% of total billed charges ,11.88,24,,,percent of total billed charges,24% of total billed charges ,1.69,39.6,
FORTAZ (CEFTAZIDIME) 1GM INJ,7043200,CDM,636,RC,J0713,HCPCS,Outpatient,,,53.5,26.75,,1.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.8,80,,,percent of total billed charges,80% of total billed charges ,12.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,13.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.84,24,,,percent of total billed charges,24% of total billed charges ,16.69,31.2,,,percent of total billed charges,31.2% of total billed charges,42.8,80,,,percent of total billed charges,80% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,1.69,42.8,
PNEUVOVAX (PNEUMOCOCCAL 23) 0.5ML VIA,7043203,CDM,636,RC,90732,HCPCS,Outpatient,,,515,257.5,,133.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,123.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,412,80,,,percent of total billed charges,80% of total billed charges ,124.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,259.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,386.25,75,,,percent of total billed charges,75% of total billed charges ,126.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,133.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,123.6,24,,,percent of total billed charges,24% of total billed charges ,160.68,31.2,,,percent of total billed charges,31.2% of total billed charges,412,80,,,percent of total billed charges,80% of total billed charges,123.6,24,,,percent of total billed charges,24% of total billed charges ,123.6,24,,,percent of total billed charges,24% of total billed charges ,123.6,412,
FORTAZ (CEFTAZIDIME) 2GM INJ,7043210,CDM,636,RC,J0713,HCPCS,Outpatient,,,64,32,,1.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,1.69,51.2,
FLAGYL (METRONIDAZOLE) 500MG TAB,7043220,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
CALMOSEPTINE (MENTHOL/ZINC) OINT,7043308,CDM,250,RC,,,Outpatient,,,45.5,22.75,,12.22,26.86,,,percent of total billed charges,26.86% of total billed charges,34.13,75,,,percent of total billed charges,75% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.22,26.86,,,percent of total billed charges,26.86% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,36.4,80,,,percent of total billed charges,80% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,36.4,
PHOS-NAK (POTASSIUM PHOS) PACKET,7043309,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
PRIMAXIN (IMIPENEM-CIL) 500MG IV,7043330,CDM,636,RC,J0743,HCPCS,Outpatient,,,193.5,96.75,,8.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,154.8,80,,,percent of total billed charges,80% of total billed charges ,46.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,97.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,145.13,75,,,percent of total billed charges,75% of total billed charges ,47.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,46.44,24,,,percent of total billed charges,24% of total billed charges ,60.37,31.2,,,percent of total billed charges,31.2% of total billed charges,154.8,80,,,percent of total billed charges,80% of total billed charges,46.44,24,,,percent of total billed charges,24% of total billed charges ,46.44,24,,,percent of total billed charges,24% of total billed charges ,8.1,154.8,
PRIMAXIN (IMIPENEM-CIL) 250MG IV,7043331,CDM,636,RC,J0743,HCPCS,Outpatient,,,83.5,41.75,,8.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.8,80,,,percent of total billed charges,80% of total billed charges ,20.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,62.63,75,,,percent of total billed charges,75% of total billed charges ,20.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.04,24,,,percent of total billed charges,24% of total billed charges ,26.05,31.2,,,percent of total billed charges,31.2% of total billed charges,66.8,80,,,percent of total billed charges,80% of total billed charges,20.04,24,,,percent of total billed charges,24% of total billed charges ,20.04,24,,,percent of total billed charges,24% of total billed charges ,8.1,66.8,
ROCEPHIN (CEFTRIAXONE) 500MG INJ,7043340,CDM,636,RC,J0696,HCPCS,Outpatient,,,84.5,42.25,,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,67.6,80,,,percent of total billed charges,80% of total billed charges ,20.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,20.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.28,24,,,percent of total billed charges,24% of total billed charges ,26.36,31.2,,,percent of total billed charges,31.2% of total billed charges,67.6,80,,,percent of total billed charges,80% of total billed charges,20.28,24,,,percent of total billed charges,24% of total billed charges ,20.28,24,,,percent of total billed charges,24% of total billed charges ,0.49,67.6,
ROCEPHIN (CEFTRIAXONE) 1GM INJ,7043350,CDM,636,RC,J0696,HCPCS,Outpatient,,,232,116,,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.6,80,,,percent of total billed charges,80% of total billed charges ,56.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,116.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,174,75,,,percent of total billed charges,75% of total billed charges ,56.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,55.68,24,,,percent of total billed charges,24% of total billed charges ,72.38,31.2,,,percent of total billed charges,31.2% of total billed charges,185.6,80,,,percent of total billed charges,80% of total billed charges,55.68,24,,,percent of total billed charges,24% of total billed charges ,55.68,24,,,percent of total billed charges,24% of total billed charges ,0.49,185.6,
ROCEPHIN (CEFTRIAXONE) 2GM INJ,7043360,CDM,636,RC,J0696,HCPCS,Outpatient,,,449,224.5,,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,107.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,359.2,80,,,percent of total billed charges,80% of total billed charges ,108.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,226.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,336.75,75,,,percent of total billed charges,75% of total billed charges ,109.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,107.76,24,,,percent of total billed charges,24% of total billed charges ,140.09,31.2,,,percent of total billed charges,31.2% of total billed charges,359.2,80,,,percent of total billed charges,80% of total billed charges,107.76,24,,,percent of total billed charges,24% of total billed charges ,107.76,24,,,percent of total billed charges,24% of total billed charges ,0.49,359.2,
LACTULOSE 10GM/15ML SOL BOTTLE,7043361,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ROCEPHIN (CEFTRIAXONE) 250MG INJ,7043370,CDM,636,RC,J0696,HCPCS,Outpatient,,,84.5,42.25,,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,67.6,80,,,percent of total billed charges,80% of total billed charges ,20.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,20.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.28,24,,,percent of total billed charges,24% of total billed charges ,26.36,31.2,,,percent of total billed charges,31.2% of total billed charges,67.6,80,,,percent of total billed charges,80% of total billed charges,20.28,24,,,percent of total billed charges,24% of total billed charges ,20.28,24,,,percent of total billed charges,24% of total billed charges ,0.49,67.6,
ZZZTIMENTIN (TICARCILLIN K CLAV) 3.1GM,7043410,CDM,250,RC,,,Outpatient,,,58.5,29.25,,15.71,26.86,,,percent of total billed charges,26.86% of total billed charges,43.88,75,,,percent of total billed charges,75% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.71,26.86,,,percent of total billed charges,26.86% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,46.8,
LIPITOR (ATORVASTATIN) 10MG TAB,7043414,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
VIBRAMYCIN (DOXYCYCLINE) 100MG INJ,7043420,CDM,250,RC,,,Outpatient,,,212,106,,56.94,26.86,,,percent of total billed charges,26.86% of total billed charges,159,75,,,percent of total billed charges,75% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,50.88,24,,,percent of total billed charges,24% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,169.6,80,,,percent of total billed charges,80% of total billed charges ,51.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,106.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,51.9,24.48,,,percent of total billed charges,24.48% of total billed charges ,56.94,26.86,,,percent of total billed charges,26.86% of total billed charges,50.88,24,,,percent of total billed charges,24% of total billed charges ,66.14,31.2,,,percent of total billed charges,31.2% of total billed charges,169.6,80,,,percent of total billed charges,80% of total billed charges,50.88,24,,,percent of total billed charges,24% of total billed charges ,50.88,24,,,percent of total billed charges,24% of total billed charges ,50.88,169.6,
ZZZZINACEF (CEFUROXIME) 1.5GM INJ,7043440,CDM,636,RC,J0697,HCPCS,Outpatient,,,50.5,25.25,,2.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40.4,80,,,percent of total billed charges,80% of total billed charges ,12.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,12.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.12,24,,,percent of total billed charges,24% of total billed charges ,15.76,31.2,,,percent of total billed charges,31.2% of total billed charges,40.4,80,,,percent of total billed charges,80% of total billed charges,12.12,24,,,percent of total billed charges,24% of total billed charges ,12.12,24,,,percent of total billed charges,24% of total billed charges ,2.03,40.4,
ZEMURON (ROCURONIUM) 50MG/5ML INJ,7043444,CDM,250,RC,,,Outpatient,,,35,17.5,,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,28,80,,,percent of total billed charges,80% of total billed charges ,8.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,10.92,31.2,,,percent of total billed charges,31.2% of total billed charges,28,80,,,percent of total billed charges,80% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,28,
ZOVIRAX (ACYCLOVIR 500MG IV SOLU,7043450,CDM,636,RC,J0133,HCPCS,Outpatient,,,88.5,44.25,,0.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,70.8,80,,,percent of total billed charges,80% of total billed charges ,21.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,44.6,50.4,,,percent of total billed charges,50.4% of total billed charges ,66.38,75,,,percent of total billed charges,75% of total billed charges ,21.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.24,24,,,percent of total billed charges,24% of total billed charges ,27.61,31.2,,,percent of total billed charges,31.2% of total billed charges,70.8,80,,,percent of total billed charges,80% of total billed charges,21.24,24,,,percent of total billed charges,24% of total billed charges ,21.24,24,,,percent of total billed charges,24% of total billed charges ,0.06,70.8,
UNASYN (AMP/SULB) 3GM INJ,7043455,CDM,636,RC,J0295,HCPCS,Outpatient,,,103,51.5,,1.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.72,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,82.4,80,,,percent of total billed charges,80% of total billed charges ,24.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,51.91,50.4,,,percent of total billed charges,50.4% of total billed charges ,77.25,75,,,percent of total billed charges,75% of total billed charges ,25.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.72,24,,,percent of total billed charges,24% of total billed charges ,32.14,31.2,,,percent of total billed charges,31.2% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,24.72,24,,,percent of total billed charges,24% of total billed charges ,24.72,24,,,percent of total billed charges,24% of total billed charges ,1.77,82.4,
ZOSYN (PIPERACILLIN/TAZ) 4.5GM INJ,7043502,CDM,636,RC,J2543,HCPCS,Outpatient,,,109.5,54.75,,1.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,87.6,80,,,percent of total billed charges,80% of total billed charges ,26.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.19,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.13,75,,,percent of total billed charges,75% of total billed charges ,26.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.28,24,,,percent of total billed charges,24% of total billed charges ,34.16,31.2,,,percent of total billed charges,31.2% of total billed charges,87.6,80,,,percent of total billed charges,80% of total billed charges,26.28,24,,,percent of total billed charges,24% of total billed charges ,26.28,24,,,percent of total billed charges,24% of total billed charges ,1.18,87.6,
ZZZSULFAMYLON (MAFENIDE ACET) 8.5% CRM,7044096,CDM,250,RC,,,Outpatient,,,358.5,179.25,,96.29,26.86,,,percent of total billed charges,26.86% of total billed charges,268.88,75,,,percent of total billed charges,75% of total billed charges ,268.88,75,,,percent of total billed charges,75% of total billed charges ,86.04,24,,,percent of total billed charges,24% of total billed charges ,268.88,75,,,percent of total billed charges,75% of total billed charges ,268.88,75,,,percent of total billed charges,75% of total billed charges ,286.8,80,,,percent of total billed charges,80% of total billed charges ,86.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,180.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,268.88,75,,,percent of total billed charges,75% of total billed charges ,87.76,24.48,,,percent of total billed charges,24.48% of total billed charges ,96.29,26.86,,,percent of total billed charges,26.86% of total billed charges,86.04,24,,,percent of total billed charges,24% of total billed charges ,111.85,31.2,,,percent of total billed charges,31.2% of total billed charges,286.8,80,,,percent of total billed charges,80% of total billed charges,86.04,24,,,percent of total billed charges,24% of total billed charges ,86.04,24,,,percent of total billed charges,24% of total billed charges ,86.04,286.8,
SEROQUEL (QUETIAPINE) 25MG TAB,7044149,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
TETAN - DIPTH-  PERT) 0.5ML SYR (ADACEL),7044253,CDM,636,RC,90715,HCPCS,Outpatient,,,301,150.5,,38.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,72.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,240.8,80,,,percent of total billed charges,80% of total billed charges ,72.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,151.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,225.75,75,,,percent of total billed charges,75% of total billed charges ,73.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,38.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,72.24,24,,,percent of total billed charges,24% of total billed charges ,93.91,31.2,,,percent of total billed charges,31.2% of total billed charges,240.8,80,,,percent of total billed charges,80% of total billed charges,72.24,24,,,percent of total billed charges,24% of total billed charges ,72.24,24,,,percent of total billed charges,24% of total billed charges ,38.31,240.8,
TETAN - DIPTH-  PERT) 0.5ML (ADACEL)<7,7044254,CDM,636,RC,90702,HCPCS,Outpatient,,,271,135.5,,72.79,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,65.04,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,216.8,80,,,percent of total billed charges,80% of total billed charges ,65.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,136.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,203.25,75,,,percent of total billed charges,75% of total billed charges ,66.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,72.79,26.86,,,percent of total billed charges,26.86% of total billed charges,65.04,24,,,percent of total billed charges,24% of total billed charges ,84.55,31.2,,,percent of total billed charges,31.2% of total billed charges,216.8,80,,,percent of total billed charges,80% of total billed charges,65.04,24,,,percent of total billed charges,24% of total billed charges ,65.04,24,,,percent of total billed charges,24% of total billed charges ,65.04,216.8,
DILAUDID (HYDROMORPHONE) 2MG TAB,7044358,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
LEXAPRO (ESCITALOPRAM) 10MG TAB,7044359,CDM,250,RC,,,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
ZZZZINC OXIDE 20% OINTMENT 28GM,7044411,CDM,250,RC,,,Outpatient,,,26,13,,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,20.8,
DEPO-MEDROL (METHYLPRED) 80MG INJ,7044463,CDM,636,RC,J1040,HCPCS,Outpatient,,,101,50.5,,9.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.8,80,,,percent of total billed charges,80% of total billed charges ,24.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,75.75,75,,,percent of total billed charges,75% of total billed charges ,24.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.24,24,,,percent of total billed charges,24% of total billed charges ,31.51,31.2,,,percent of total billed charges,31.2% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,24.24,24,,,percent of total billed charges,24% of total billed charges ,24.24,24,,,percent of total billed charges,24% of total billed charges ,9.8,80.8,
LOVENOX (ENOXAPARIN) 80MG/0.8ML SYRINGE,7044464,CDM,636,RC,J1650,HCPCS,Outpatient,,,353.5,176.75,,94.95,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,84.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,282.8,80,,,percent of total billed charges,80% of total billed charges ,85.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,178.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,265.13,75,,,percent of total billed charges,75% of total billed charges ,86.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,94.95,26.86,,,percent of total billed charges,26.86% of total billed charges,84.84,24,,,percent of total billed charges,24% of total billed charges ,110.29,31.2,,,percent of total billed charges,31.2% of total billed charges,282.8,80,,,percent of total billed charges,80% of total billed charges,84.84,24,,,percent of total billed charges,24% of total billed charges ,84.84,24,,,percent of total billed charges,24% of total billed charges ,84.84,282.8,
LIDOCAINE 1% 500MG/50ML VIAL,7044516,CDM,636,RC,J2001,HCPCS,Outpatient,,,38,19,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,0.03,30.4,
LABETALOL 20MG/4ML SYRINGE,7044673,CDM,250,RC,J1920,HCPCS,Outpatient,,,60.5,30.25,,16.25,26.86,,,percent of total billed charges,26.86% of total billed charges,45.38,75,,,percent of total billed charges,75% of total billed charges ,45.38,75,,,percent of total billed charges,75% of total billed charges ,14.52,24,,,percent of total billed charges,24% of total billed charges ,45.38,75,,,percent of total billed charges,75% of total billed charges ,45.38,75,,,percent of total billed charges,75% of total billed charges ,48.4,80,,,percent of total billed charges,80% of total billed charges ,14.67,24.24,,,percent of total billed charges,24.24% of total billed charges ,30.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,45.38,75,,,percent of total billed charges,75% of total billed charges ,14.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.25,26.86,,,percent of total billed charges,26.86% of total billed charges,14.52,24,,,percent of total billed charges,24% of total billed charges ,18.88,31.2,,,percent of total billed charges,31.2% of total billed charges,48.4,80,,,percent of total billed charges,80% of total billed charges,14.52,24,,,percent of total billed charges,24% of total billed charges ,14.52,24,,,percent of total billed charges,24% of total billed charges ,14.52,48.4,
LOVENOX (ENOXAPARIN) 30MG/0.3ML SYRINGE,7044674,CDM,636,RC,J1650,HCPCS,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
VERSED (MIDAZOLAM) 50MG/10ML INJECT,7044772,CDM,636,RC,J2250,HCPCS,Outpatient,,,80.5,40.25,,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,64.4,80,,,percent of total billed charges,80% of total billed charges ,19.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,40.57,50.4,,,percent of total billed charges,50.4% of total billed charges ,60.38,75,,,percent of total billed charges,75% of total billed charges ,19.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,19.32,24,,,percent of total billed charges,24% of total billed charges ,25.12,31.2,,,percent of total billed charges,31.2% of total billed charges,64.4,80,,,percent of total billed charges,80% of total billed charges,19.32,24,,,percent of total billed charges,24% of total billed charges ,19.32,24,,,percent of total billed charges,24% of total billed charges ,0.14,64.4,
ARIXTRA (FONDAPARINUX) 2.5MG/0.5ML,7044779,CDM,636,RC,J1652,HCPCS,Outpatient,,,273,136.5,,73.33,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,65.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,218.4,80,,,percent of total billed charges,80% of total billed charges ,66.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,137.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,204.75,75,,,percent of total billed charges,75% of total billed charges ,66.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.33,26.86,,,percent of total billed charges,26.86% of total billed charges,65.52,24,,,percent of total billed charges,24% of total billed charges ,85.18,31.2,,,percent of total billed charges,31.2% of total billed charges,218.4,80,,,percent of total billed charges,80% of total billed charges,65.52,24,,,percent of total billed charges,24% of total billed charges ,65.52,24,,,percent of total billed charges,24% of total billed charges ,65.52,218.4,
ZZZSTADOL (BUTORPHANOL) 2MG/ML INJECT,7044883,CDM,636,RC,J0595,HCPCS,Outpatient,,,37,18.5,,2.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,2.8,29.6,
NS (0.9% SOD CHLORIDE) 250ML IVPB,7044884,CDM,636,RC,J7030,HCPCS,Outpatient,,,64,32,,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,2.69,51.2,
ASPIRIN 300MG SUPP,7044988,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
LAMICTAL (LAMOTRIGINE) 25MG TAB,7045041,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
NS (0.9% SOD CHLORIDE) 500ML IVPB,7045084,CDM,636,RC,J7030,HCPCS,Outpatient,,,64,32,,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,2.69,51.2,
ROBITUSSIN (GUAIFENESIN) 100MG/5ML UD,7045091,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
OXYCODONE HCL 5MG TAB,7045093,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
HYDROCHLOROTHIAZIDE 12.5MG TAB,7045146,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
CARDIZEM (DILTIAZEM) 25MG/5ML INJ,7045196,CDM,250,RC,,,Outpatient,,,77.5,38.75,,20.82,26.86,,,percent of total billed charges,26.86% of total billed charges,58.13,75,,,percent of total billed charges,75% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,18.6,24,,,percent of total billed charges,24% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,62,80,,,percent of total billed charges,80% of total billed charges ,18.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.13,75,,,percent of total billed charges,75% of total billed charges ,18.97,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.82,26.86,,,percent of total billed charges,26.86% of total billed charges,18.6,24,,,percent of total billed charges,24% of total billed charges ,24.18,31.2,,,percent of total billed charges,31.2% of total billed charges,62,80,,,percent of total billed charges,80% of total billed charges,18.6,24,,,percent of total billed charges,24% of total billed charges ,18.6,24,,,percent of total billed charges,24% of total billed charges ,18.6,62,
CRESTOR (ROSUVASTATIN CAL) 10MG TAB,7045197,CDM,250,RC,,,Outpatient,,,16,8,,4.3,26.86,,,percent of total billed charges,26.86% of total billed charges,12,75,,,percent of total billed charges,75% of total billed charges ,12,75,,,percent of total billed charges,75% of total billed charges ,3.84,24,,,percent of total billed charges,24% of total billed charges ,12,75,,,percent of total billed charges,75% of total billed charges ,12,75,,,percent of total billed charges,75% of total billed charges ,12.8,80,,,percent of total billed charges,80% of total billed charges ,3.88,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,12,75,,,percent of total billed charges,75% of total billed charges ,3.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.3,26.86,,,percent of total billed charges,26.86% of total billed charges,3.84,24,,,percent of total billed charges,24% of total billed charges ,4.99,31.2,,,percent of total billed charges,31.2% of total billed charges,12.8,80,,,percent of total billed charges,80% of total billed charges,3.84,24,,,percent of total billed charges,24% of total billed charges ,3.84,24,,,percent of total billed charges,24% of total billed charges ,3.84,12.8,
LACTINEX (ACIDOPHILUS) CHEWABLE TAB,7045198,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
NS (0.9% SOD CHLORIDE) 1000ML IV,7045199,CDM,636,RC,J7030,HCPCS,Outpatient,,,64,32,,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,2.69,51.2,
FLEET ENEMA (PHOSM-B PHOSDI-BA)  66ML,7045249,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
REQUIP (ROPINIROLE) 1MG TAB,7045301,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
NORMAL SALINE FLUSH 10ML SYRINGE,7045304,CDM,250,RC,,,Outpatient,,,29,14.5,,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,23.2,80,,,percent of total billed charges,80% of total billed charges ,7.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,21.75,75,,,percent of total billed charges,75% of total billed charges ,7.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.79,26.86,,,percent of total billed charges,26.86% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,9.05,31.2,,,percent of total billed charges,31.2% of total billed charges,23.2,80,,,percent of total billed charges,80% of total billed charges,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,24,,,percent of total billed charges,24% of total billed charges ,6.96,23.2,
DEPAKOTE ER (DIVALPROEX) 500MG TAB,7045511,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ZZZNEUPOGEN (FILGRASTIN) 480MG/1.6ML VI,7045561,CDM,636,RC,,,Outpatient,,,2573,1286.5,,691.11,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,617.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2058.4,80,,,percent of total billed charges,80% of total billed charges ,623.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,1296.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,1929.75,75,,,percent of total billed charges,75% of total billed charges ,629.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,691.11,26.86,,,percent of total billed charges,26.86% of total billed charges,617.52,24,,,percent of total billed charges,24% of total billed charges ,802.78,31.2,,,percent of total billed charges,31.2% of total billed charges,2058.4,80,,,percent of total billed charges,80% of total billed charges,617.52,24,,,percent of total billed charges,24% of total billed charges ,617.52,24,,,percent of total billed charges,24% of total billed charges ,617.52,2058.4,
ZZZDESYREL (TRAZODONE) 100MG TAB,7045564,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
PROVENTIL SOL (ALBUTEROL) 2.5MG/0.5ML UD,7045616,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
TOPAMAX (TOPIRAMATE) 25MG TAB,7045721,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
TRILEPTAL (OXCARBAZEPINE) 300MG TB,7045774,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ZZZDIURIL (CHLOROTHIAZIDE SOD) 500MG/VL,7045826,CDM,636,RC,J1205,HCPCS,Outpatient,,,561.5,280.75,,150.82,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,134.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,449.2,80,,,percent of total billed charges,80% of total billed charges ,136.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,283,50.4,,,percent of total billed charges,50.4% of total billed charges ,421.13,75,,,percent of total billed charges,75% of total billed charges ,137.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,150.82,26.86,,,percent of total billed charges,26.86% of total billed charges,134.76,24,,,percent of total billed charges,24% of total billed charges ,175.19,31.2,,,percent of total billed charges,31.2% of total billed charges,449.2,80,,,percent of total billed charges,80% of total billed charges,134.76,24,,,percent of total billed charges,24% of total billed charges ,134.76,24,,,percent of total billed charges,24% of total billed charges ,134.76,449.2,
ZZZNOVOLOG (ASPART) 100 UNIT/ML PEN,7045827,CDM,636,RC,J1817,HCPCS,Outpatient,,,544,272,,146.12,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,130.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,435.2,80,,,percent of total billed charges,80% of total billed charges ,131.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,274.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,408,75,,,percent of total billed charges,75% of total billed charges ,133.17,24.48,,,percent of total billed charges,24.48% of total billed charges ,146.12,26.86,,,percent of total billed charges,26.86% of total billed charges,130.56,24,,,percent of total billed charges,24% of total billed charges ,169.73,31.2,,,percent of total billed charges,31.2% of total billed charges,435.2,80,,,percent of total billed charges,80% of total billed charges,130.56,24,,,percent of total billed charges,24% of total billed charges ,130.56,24,,,percent of total billed charges,24% of total billed charges ,130.56,435.2,
OMNICEF (CEFDINIR) 300MG CAP,7046037,CDM,250,RC,,,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
RECLAST (ZOLEDRONIC ACID) 5MG/100ML,7046352,CDM,636,RC,J3489,HCPCS,Outpatient,,,1469,734.5,,7.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,352.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1175.2,80,,,percent of total billed charges,80% of total billed charges ,356.09,24.24,,,percent of total billed charges,24.24% of total billed charges ,740.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,1101.75,75,,,percent of total billed charges,75% of total billed charges ,359.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,352.56,24,,,percent of total billed charges,24% of total billed charges ,458.33,31.2,,,percent of total billed charges,31.2% of total billed charges,1175.2,80,,,percent of total billed charges,80% of total billed charges,352.56,24,,,percent of total billed charges,24% of total billed charges ,352.56,24,,,percent of total billed charges,24% of total billed charges ,7.21,1175.2,
FLONASE (FLUTICASONE PROP) 50MCG SPRAY,7046457,CDM,250,RC,,,Outpatient,,,419,209.5,,112.54,26.86,,,percent of total billed charges,26.86% of total billed charges,314.25,75,,,percent of total billed charges,75% of total billed charges ,314.25,75,,,percent of total billed charges,75% of total billed charges ,100.56,24,,,percent of total billed charges,24% of total billed charges ,314.25,75,,,percent of total billed charges,75% of total billed charges ,314.25,75,,,percent of total billed charges,75% of total billed charges ,335.2,80,,,percent of total billed charges,80% of total billed charges ,101.57,24.24,,,percent of total billed charges,24.24% of total billed charges ,211.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,314.25,75,,,percent of total billed charges,75% of total billed charges ,102.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,112.54,26.86,,,percent of total billed charges,26.86% of total billed charges,100.56,24,,,percent of total billed charges,24% of total billed charges ,130.73,31.2,,,percent of total billed charges,31.2% of total billed charges,335.2,80,,,percent of total billed charges,80% of total billed charges,100.56,24,,,percent of total billed charges,24% of total billed charges ,100.56,24,,,percent of total billed charges,24% of total billed charges ,100.56,335.2,
REMICADE (INFLIXIMAB) 100MG VIAL,7046561,CDM,636,RC,J1745,HCPCS,Outpatient,,,5611.5,2805.75,,32.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1346.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4489.2,80,,,percent of total billed charges,80% of total billed charges ,1360.23,24.24,,,percent of total billed charges,24.24% of total billed charges ,2828.2,50.4,,,percent of total billed charges,50.4% of total billed charges ,4208.63,75,,,percent of total billed charges,75% of total billed charges ,1373.7,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,1346.76,24,,,percent of total billed charges,24% of total billed charges ,1750.79,31.2,,,percent of total billed charges,31.2% of total billed charges,4489.2,80,,,percent of total billed charges,80% of total billed charges,1346.76,24,,,percent of total billed charges,24% of total billed charges ,1346.76,24,,,percent of total billed charges,24% of total billed charges ,32.16,4489.2,
FISH OIL (OMEGA 3) 1000MG CAP,7046592,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
LOPRESSOR (METOPROLOL) 25MG TAB,7046666,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
IMODIUM (LOPERAMIDE) 1MG/7.5ML LIQ,7046667,CDM,250,RC,,,Outpatient,,,35,17.5,,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,28,80,,,percent of total billed charges,80% of total billed charges ,8.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,10.92,31.2,,,percent of total billed charges,31.2% of total billed charges,28,80,,,percent of total billed charges,80% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,28,
SPIRIVA (TIOTROPIUM BROM) INHALER,7046719,CDM,250,RC,,,Outpatient,,,490,245,,131.61,26.86,,,percent of total billed charges,26.86% of total billed charges,367.5,75,,,percent of total billed charges,75% of total billed charges ,367.5,75,,,percent of total billed charges,75% of total billed charges ,117.6,24,,,percent of total billed charges,24% of total billed charges ,367.5,75,,,percent of total billed charges,75% of total billed charges ,367.5,75,,,percent of total billed charges,75% of total billed charges ,392,80,,,percent of total billed charges,80% of total billed charges ,118.78,24.24,,,percent of total billed charges,24.24% of total billed charges ,246.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,367.5,75,,,percent of total billed charges,75% of total billed charges ,119.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,131.61,26.86,,,percent of total billed charges,26.86% of total billed charges,117.6,24,,,percent of total billed charges,24% of total billed charges ,152.88,31.2,,,percent of total billed charges,31.2% of total billed charges,392,80,,,percent of total billed charges,80% of total billed charges,117.6,24,,,percent of total billed charges,24% of total billed charges ,117.6,24,,,percent of total billed charges,24% of total billed charges ,117.6,392,
REGLAN (METOCLOPRAMIDE) 5MG TAB,7046772,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
OCEAN (SOD CHL) NASAL SPRAY 45ML,7046785,CDM,250,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
ZZZVENOFER (IRON SUCROSE) 200MG/10ML,7046877,CDM,636,RC,J1756,HCPCS,Outpatient,,,513,256.5,,0.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,123.12,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,410.4,80,,,percent of total billed charges,80% of total billed charges ,124.35,24.24,,,percent of total billed charges,24.24% of total billed charges ,258.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,384.75,75,,,percent of total billed charges,75% of total billed charges ,125.58,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,123.12,24,,,percent of total billed charges,24% of total billed charges ,160.06,31.2,,,percent of total billed charges,31.2% of total billed charges,410.4,80,,,percent of total billed charges,80% of total billed charges,123.12,24,,,percent of total billed charges,24% of total billed charges ,123.12,24,,,percent of total billed charges,24% of total billed charges ,0.22,410.4,
ZZZQUELICIN (SUCCINYL) 200MG/10ML INJ,7047000,CDM,636,RC,J0330,HCPCS,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
CILOXAN (CIPROFLOXACIN) 0.3% 3.5GM,7047034,CDM,250,RC,,,Outpatient,,,1001,500.5,,268.87,26.86,,,percent of total billed charges,26.86% of total billed charges,750.75,75,,,percent of total billed charges,75% of total billed charges ,750.75,75,,,percent of total billed charges,75% of total billed charges ,240.24,24,,,percent of total billed charges,24% of total billed charges ,750.75,75,,,percent of total billed charges,75% of total billed charges ,750.75,75,,,percent of total billed charges,75% of total billed charges ,800.8,80,,,percent of total billed charges,80% of total billed charges ,242.64,24.24,,,percent of total billed charges,24.24% of total billed charges ,504.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,750.75,75,,,percent of total billed charges,75% of total billed charges ,245.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,268.87,26.86,,,percent of total billed charges,26.86% of total billed charges,240.24,24,,,percent of total billed charges,24% of total billed charges ,312.31,31.2,,,percent of total billed charges,31.2% of total billed charges,800.8,80,,,percent of total billed charges,80% of total billed charges,240.24,24,,,percent of total billed charges,24% of total billed charges ,240.24,24,,,percent of total billed charges,24% of total billed charges ,240.24,800.8,
BICILLIN L-A (PEN G BENZ) 2.4MU SYR,7047050,CDM,636,RC,,,Outpatient,,,2690.45,1345.23,,722.65,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,645.71,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2152.36,80,,,percent of total billed charges,80% of total billed charges ,652.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,1355.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,2017.84,75,,,percent of total billed charges,75% of total billed charges ,658.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,722.65,26.86,,,percent of total billed charges,26.86% of total billed charges,645.71,24,,,percent of total billed charges,24% of total billed charges ,839.42,31.2,,,percent of total billed charges,31.2% of total billed charges,2152.36,80,,,percent of total billed charges,80% of total billed charges,645.71,24,,,percent of total billed charges,24% of total billed charges ,645.71,24,,,percent of total billed charges,24% of total billed charges ,645.71,2152.36,
NEUPOGEN (FILGRASTIN) 300MCG/ML VIAL,7047085,CDM,636,RC,J1442,HCPCS,Outpatient,,,1628.5,814.25,,0.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,390.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1302.8,80,,,percent of total billed charges,80% of total billed charges ,394.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,820.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,1221.38,75,,,percent of total billed charges,75% of total billed charges ,398.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,390.84,24,,,percent of total billed charges,24% of total billed charges ,508.09,31.2,,,percent of total billed charges,31.2% of total billed charges,1302.8,80,,,percent of total billed charges,80% of total billed charges,390.84,24,,,percent of total billed charges,24% of total billed charges ,390.84,24,,,percent of total billed charges,24% of total billed charges ,0.99,1302.8,
LEVAQUIN (LEVOFLOXACIN) 750MG/150ML PREM,7047087,CDM,636,RC,J1956,HCPCS,Outpatient,,,75,37.5,,20.15,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60,80,,,percent of total billed charges,80% of total billed charges ,18.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,18.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.15,26.86,,,percent of total billed charges,26.86% of total billed charges,18,24,,,percent of total billed charges,24% of total billed charges ,23.4,31.2,,,percent of total billed charges,31.2% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,18,24,,,percent of total billed charges,24% of total billed charges ,18,24,,,percent of total billed charges,24% of total billed charges ,18,60,
BICILLIN L-A (PEN G BENZ) 1.2MU SYR,7047100,CDM,636,RC,J0561,HCPCS,Outpatient,,,663.5,331.75,,21.73,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,530.8,80,,,percent of total billed charges,80% of total billed charges ,160.83,24.24,,,percent of total billed charges,24.24% of total billed charges ,334.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,497.63,75,,,percent of total billed charges,75% of total billed charges ,162.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.73,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,159.24,24,,,percent of total billed charges,24% of total billed charges ,207.01,31.2,,,percent of total billed charges,31.2% of total billed charges,530.8,80,,,percent of total billed charges,80% of total billed charges,159.24,24,,,percent of total billed charges,24% of total billed charges ,159.24,24,,,percent of total billed charges,24% of total billed charges ,21.73,530.8,
ZZZJANUVIA (SITAGLIPTIN)100MG TAB,7047139,CDM,250,RC,,,Outpatient,,,84.5,42.25,,22.7,26.86,,,percent of total billed charges,26.86% of total billed charges,63.38,75,,,percent of total billed charges,75% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,20.28,24,,,percent of total billed charges,24% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,67.6,80,,,percent of total billed charges,80% of total billed charges ,20.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,20.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.7,26.86,,,percent of total billed charges,26.86% of total billed charges,20.28,24,,,percent of total billed charges,24% of total billed charges ,26.36,31.2,,,percent of total billed charges,31.2% of total billed charges,67.6,80,,,percent of total billed charges,80% of total billed charges,20.28,24,,,percent of total billed charges,24% of total billed charges ,20.28,24,,,percent of total billed charges,24% of total billed charges ,20.28,67.6,
TETANUS DIPH TOX/PF) 0.5ML (TENIVAC),7047148,CDM,636,RC,90714,HCPCS,Outpatient,,,298.5,149.25,,30.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,238.8,80,,,percent of total billed charges,80% of total billed charges ,72.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,150.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.88,75,,,percent of total billed charges,75% of total billed charges ,73.07,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.64,24,,,percent of total billed charges,24% of total billed charges ,93.13,31.2,,,percent of total billed charges,31.2% of total billed charges,238.8,80,,,percent of total billed charges,80% of total billed charges,71.64,24,,,percent of total billed charges,24% of total billed charges ,71.64,24,,,percent of total billed charges,24% of total billed charges ,30.34,238.8,
ATIVAN (LORAZEPAM) 2MG/ML 1ML VIAL,7047160,CDM,636,RC,J2060,HCPCS,Outpatient,,,18,9,,4.83,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.4,80,,,percent of total billed charges,80% of total billed charges ,4.36,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.5,75,,,percent of total billed charges,75% of total billed charges ,4.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.83,26.86,,,percent of total billed charges,26.86% of total billed charges,4.32,24,,,percent of total billed charges,24% of total billed charges ,5.62,31.2,,,percent of total billed charges,31.2% of total billed charges,14.4,80,,,percent of total billed charges,80% of total billed charges,4.32,24,,,percent of total billed charges,24% of total billed charges ,4.32,24,,,percent of total billed charges,24% of total billed charges ,4.32,14.4,
ZZZPROTAMINE 50MG/10ML  INJ,7047170,CDM,636,RC,J2720,HCPCS,Outpatient,,,79.5,39.75,,1.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.08,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,63.6,80,,,percent of total billed charges,80% of total billed charges ,19.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,40.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,19.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,19.08,24,,,percent of total billed charges,24% of total billed charges ,24.8,31.2,,,percent of total billed charges,31.2% of total billed charges,63.6,80,,,percent of total billed charges,80% of total billed charges,19.08,24,,,percent of total billed charges,24% of total billed charges ,19.08,24,,,percent of total billed charges,24% of total billed charges ,1.66,63.6,
ENGERIX-B (HEPATITIS B) 20MCG/ML PFS,7047229,CDM,636,RC,90740,HCPCS,Outpatient,,,349,174.5,,93.74,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,83.76,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,279.2,80,,,percent of total billed charges,80% of total billed charges ,84.6,24.24,,,percent of total billed charges,24.24% of total billed charges ,175.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,261.75,75,,,percent of total billed charges,75% of total billed charges ,85.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,93.74,26.86,,,percent of total billed charges,26.86% of total billed charges,83.76,24,,,percent of total billed charges,24% of total billed charges ,108.89,31.2,,,percent of total billed charges,31.2% of total billed charges,279.2,80,,,percent of total billed charges,80% of total billed charges,83.76,24,,,percent of total billed charges,24% of total billed charges ,83.76,24,,,percent of total billed charges,24% of total billed charges ,83.76,279.2,
INSULIN-REGULAR (HUMULIN R) 1000U/10ML,7047234,CDM,636,RC,J1817,HCPCS,Outpatient,,,1,0.5,,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.8,80,,,percent of total billed charges,80% of total billed charges ,0.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,0.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.31,31.2,,,percent of total billed charges,31.2% of total billed charges,0.8,80,,,percent of total billed charges,80% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,0.8,
SYMBICORT (BUDES/FORM 160/4.5) INH,7047294,CDM,250,RC,,,Outpatient,,,1591,795.5,,427.34,26.86,,,percent of total billed charges,26.86% of total billed charges,1193.25,75,,,percent of total billed charges,75% of total billed charges ,1193.25,75,,,percent of total billed charges,75% of total billed charges ,381.84,24,,,percent of total billed charges,24% of total billed charges ,1193.25,75,,,percent of total billed charges,75% of total billed charges ,1193.25,75,,,percent of total billed charges,75% of total billed charges ,1272.8,80,,,percent of total billed charges,80% of total billed charges ,385.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,801.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,1193.25,75,,,percent of total billed charges,75% of total billed charges ,389.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,427.34,26.86,,,percent of total billed charges,26.86% of total billed charges,381.84,24,,,percent of total billed charges,24% of total billed charges ,496.39,31.2,,,percent of total billed charges,31.2% of total billed charges,1272.8,80,,,percent of total billed charges,80% of total billed charges,381.84,24,,,percent of total billed charges,24% of total billed charges ,381.84,24,,,percent of total billed charges,24% of total billed charges ,381.84,1272.8,
BACID (ACIDOPH L.BULG BIF.B S.) TAB,7047340,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
PPD TEST (TUBERCULIN) 0.1ML,7047370,CDM,302,RC,86580,HCPCS,Outpatient,,,63,31.5,,8.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,8.13,50.4,
ZZZNEOSPORIN GU (NEOMYC/POLYM) IRRIGANT,7047390,CDM,250,RC,,,Outpatient,,,186.5,93.25,,50.09,26.86,,,percent of total billed charges,26.86% of total billed charges,139.88,75,,,percent of total billed charges,75% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,44.76,24,,,percent of total billed charges,24% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,149.2,80,,,percent of total billed charges,80% of total billed charges ,45.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,94,50.4,,,percent of total billed charges,50.4% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,45.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,50.09,26.86,,,percent of total billed charges,26.86% of total billed charges,44.76,24,,,percent of total billed charges,24% of total billed charges ,58.19,31.2,,,percent of total billed charges,31.2% of total billed charges,149.2,80,,,percent of total billed charges,80% of total billed charges,44.76,24,,,percent of total billed charges,24% of total billed charges ,44.76,24,,,percent of total billed charges,24% of total billed charges ,44.76,149.2,
PHENERGAN (PROMETHAZ) 12.5MG SUPP,7047420,CDM,250,RC,,,Outpatient,,,97,48.5,,26.05,26.86,,,percent of total billed charges,26.86% of total billed charges,72.75,75,,,percent of total billed charges,75% of total billed charges ,72.75,75,,,percent of total billed charges,75% of total billed charges ,23.28,24,,,percent of total billed charges,24% of total billed charges ,72.75,75,,,percent of total billed charges,75% of total billed charges ,72.75,75,,,percent of total billed charges,75% of total billed charges ,77.6,80,,,percent of total billed charges,80% of total billed charges ,23.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.89,50.4,,,percent of total billed charges,50.4% of total billed charges ,72.75,75,,,percent of total billed charges,75% of total billed charges ,23.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.05,26.86,,,percent of total billed charges,26.86% of total billed charges,23.28,24,,,percent of total billed charges,24% of total billed charges ,30.26,31.2,,,percent of total billed charges,31.2% of total billed charges,77.6,80,,,percent of total billed charges,80% of total billed charges,23.28,24,,,percent of total billed charges,24% of total billed charges ,23.28,24,,,percent of total billed charges,24% of total billed charges ,23.28,77.6,
PHENERGAN (PROMETHAZ) 25MG SUPP,7047430,CDM,250,RC,,,Outpatient,,,97,48.5,,26.05,26.86,,,percent of total billed charges,26.86% of total billed charges,72.75,75,,,percent of total billed charges,75% of total billed charges ,72.75,75,,,percent of total billed charges,75% of total billed charges ,23.28,24,,,percent of total billed charges,24% of total billed charges ,72.75,75,,,percent of total billed charges,75% of total billed charges ,72.75,75,,,percent of total billed charges,75% of total billed charges ,77.6,80,,,percent of total billed charges,80% of total billed charges ,23.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.89,50.4,,,percent of total billed charges,50.4% of total billed charges ,72.75,75,,,percent of total billed charges,75% of total billed charges ,23.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.05,26.86,,,percent of total billed charges,26.86% of total billed charges,23.28,24,,,percent of total billed charges,24% of total billed charges ,30.26,31.2,,,percent of total billed charges,31.2% of total billed charges,77.6,80,,,percent of total billed charges,80% of total billed charges,23.28,24,,,percent of total billed charges,24% of total billed charges ,23.28,24,,,percent of total billed charges,24% of total billed charges ,23.28,77.6,
ZZZASPIRIN 600MG SUPP,7047440,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
CHLORASEPTIC SORE THROAT SPRAY 6OZ,7047454,CDM,250,RC,,,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
"ZZZBACITRACIN 50,000 UNIT INJ",7047460,CDM,636,RC,,,Outpatient,,,75,37.5,,20.15,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60,80,,,percent of total billed charges,80% of total billed charges ,18.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,18.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.15,26.86,,,percent of total billed charges,26.86% of total billed charges,18,24,,,percent of total billed charges,24% of total billed charges ,23.4,31.2,,,percent of total billed charges,31.2% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,18,24,,,percent of total billed charges,24% of total billed charges ,18,24,,,percent of total billed charges,24% of total billed charges ,18,60,
ATRACURIUM 50MG/5ML INJ,7047470,CDM,250,RC,,,Outpatient,,,49.5,24.75,,13.3,26.86,,,percent of total billed charges,26.86% of total billed charges,37.13,75,,,percent of total billed charges,75% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,11.88,24,,,percent of total billed charges,24% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,39.6,80,,,percent of total billed charges,80% of total billed charges ,12,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,12.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.3,26.86,,,percent of total billed charges,26.86% of total billed charges,11.88,24,,,percent of total billed charges,24% of total billed charges ,15.44,31.2,,,percent of total billed charges,31.2% of total billed charges,39.6,80,,,percent of total billed charges,80% of total billed charges,11.88,24,,,percent of total billed charges,24% of total billed charges ,11.88,24,,,percent of total billed charges,24% of total billed charges ,11.88,39.6,
EPIPEN (EPINEPHRINE) 0.3MG INJECTOR,7047559,CDM,636,RC,J0171,HCPCS,Outpatient,,,759,379.5,,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,182.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,607.2,80,,,percent of total billed charges,80% of total billed charges ,183.98,24.24,,,percent of total billed charges,24.24% of total billed charges ,382.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,569.25,75,,,percent of total billed charges,75% of total billed charges ,185.8,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,182.16,24,,,percent of total billed charges,24% of total billed charges ,236.81,31.2,,,percent of total billed charges,31.2% of total billed charges,607.2,80,,,percent of total billed charges,80% of total billed charges,182.16,24,,,percent of total billed charges,24% of total billed charges ,182.16,24,,,percent of total billed charges,24% of total billed charges ,0.75,607.2,
INSULIN-INTERMEDIATE (HUMULIN N) PEN,7047681,CDM,250,RC,,,Outpatient,,,581,290.5,,156.06,26.86,,,percent of total billed charges,26.86% of total billed charges,435.75,75,,,percent of total billed charges,75% of total billed charges ,435.75,75,,,percent of total billed charges,75% of total billed charges ,139.44,24,,,percent of total billed charges,24% of total billed charges ,435.75,75,,,percent of total billed charges,75% of total billed charges ,435.75,75,,,percent of total billed charges,75% of total billed charges ,464.8,80,,,percent of total billed charges,80% of total billed charges ,140.83,24.24,,,percent of total billed charges,24.24% of total billed charges ,292.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,435.75,75,,,percent of total billed charges,75% of total billed charges ,142.23,24.48,,,percent of total billed charges,24.48% of total billed charges ,156.06,26.86,,,percent of total billed charges,26.86% of total billed charges,139.44,24,,,percent of total billed charges,24% of total billed charges ,181.27,31.2,,,percent of total billed charges,31.2% of total billed charges,464.8,80,,,percent of total billed charges,80% of total billed charges,139.44,24,,,percent of total billed charges,24% of total billed charges ,139.44,24,,,percent of total billed charges,24% of total billed charges ,139.44,464.8,
MEGACE (MEGESTEROL) 400MG/10ML UD,7047821,CDM,250,RC,,,Outpatient,,,35,17.5,,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,28,80,,,percent of total billed charges,80% of total billed charges ,8.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,10.92,31.2,,,percent of total billed charges,31.2% of total billed charges,28,80,,,percent of total billed charges,80% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,28,
ANUSOL (HARD FAT/PHENYL) SUPP,7047979,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
LIDOCAINE 2% ORAL(VISCOUS) 15ML UD,7048084,CDM,250,RC,,,Outpatient,,,104.5,52.25,,28.07,26.86,,,percent of total billed charges,26.86% of total billed charges,78.38,75,,,percent of total billed charges,75% of total billed charges ,78.38,75,,,percent of total billed charges,75% of total billed charges ,25.08,24,,,percent of total billed charges,24% of total billed charges ,78.38,75,,,percent of total billed charges,75% of total billed charges ,78.38,75,,,percent of total billed charges,75% of total billed charges ,83.6,80,,,percent of total billed charges,80% of total billed charges ,25.33,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.67,50.4,,,percent of total billed charges,50.4% of total billed charges ,78.38,75,,,percent of total billed charges,75% of total billed charges ,25.58,24.48,,,percent of total billed charges,24.48% of total billed charges ,28.07,26.86,,,percent of total billed charges,26.86% of total billed charges,25.08,24,,,percent of total billed charges,24% of total billed charges ,32.6,31.2,,,percent of total billed charges,31.2% of total billed charges,83.6,80,,,percent of total billed charges,80% of total billed charges,25.08,24,,,percent of total billed charges,24% of total billed charges ,25.08,24,,,percent of total billed charges,24% of total billed charges ,25.08,83.6,
ZZZLOZOL (INDAPAMIDE) 1.25MG TAB,7048284,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZTIGAN (TRIMETHOBENZAPRINE) 300MG CP,7048346,CDM,250,RC,,,Outpatient,,,17.5,8.75,,4.7,26.86,,,percent of total billed charges,26.86% of total billed charges,13.13,75,,,percent of total billed charges,75% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,4.2,24,,,percent of total billed charges,24% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,14,80,,,percent of total billed charges,80% of total billed charges ,4.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.13,75,,,percent of total billed charges,75% of total billed charges ,4.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.7,26.86,,,percent of total billed charges,26.86% of total billed charges,4.2,24,,,percent of total billed charges,24% of total billed charges ,5.46,31.2,,,percent of total billed charges,31.2% of total billed charges,14,80,,,percent of total billed charges,80% of total billed charges,4.2,24,,,percent of total billed charges,24% of total billed charges ,4.2,24,,,percent of total billed charges,24% of total billed charges ,4.2,14,
AMOXICILLIN SUSP 200MG/5ML,7048347,CDM,250,RC,,,Outpatient,,,36,18,,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,28.8,80,,,percent of total billed charges,80% of total billed charges ,8.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,11.23,31.2,,,percent of total billed charges,31.2% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,28.8,
GEODON (ZIPRASIDONE) 20MG VIAL,7048399,CDM,636,RC,J3486,HCPCS,Outpatient,,,296.5,148.25,,9.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,237.2,80,,,percent of total billed charges,80% of total billed charges ,71.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,149.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,222.38,75,,,percent of total billed charges,75% of total billed charges ,72.58,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.16,24,,,percent of total billed charges,24% of total billed charges ,92.51,31.2,,,percent of total billed charges,31.2% of total billed charges,237.2,80,,,percent of total billed charges,80% of total billed charges,71.16,24,,,percent of total billed charges,24% of total billed charges ,71.16,24,,,percent of total billed charges,24% of total billed charges ,9.76,237.2,
ZZZTRANXENE (CLORAZEPATE) 3.75MG CAP,7048417,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
AMOXICILLIN SUSP 400MG/5ML,7048452,CDM,250,RC,,,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
NF-AVODART (DUTASTERIDE) 0.5MG CAP,7048504,CDM,250,RC,,,Outpatient,,,42,21,,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,33.6,80,,,percent of total billed charges,80% of total billed charges ,10.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,13.1,31.2,,,percent of total billed charges,31.2% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,33.6,
ZZZHALDOL DECONATE (HALOP DEC) 50MG/ML,7048609,CDM,636,RC,J1631,HCPCS,Outpatient,,,160.5,80.25,,8.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,128.4,80,,,percent of total billed charges,80% of total billed charges ,38.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,80.89,50.4,,,percent of total billed charges,50.4% of total billed charges ,120.38,75,,,percent of total billed charges,75% of total billed charges ,39.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,38.52,24,,,percent of total billed charges,24% of total billed charges ,50.08,31.2,,,percent of total billed charges,31.2% of total billed charges,128.4,80,,,percent of total billed charges,80% of total billed charges,38.52,24,,,percent of total billed charges,24% of total billed charges ,38.52,24,,,percent of total billed charges,24% of total billed charges ,8.78,128.4,
PROVENTIL HFA (ALBUTEROL) INHALER,7048924,CDM,250,RC,,,Outpatient,,,444,222,,119.26,26.86,,,percent of total billed charges,26.86% of total billed charges,333,75,,,percent of total billed charges,75% of total billed charges ,333,75,,,percent of total billed charges,75% of total billed charges ,106.56,24,,,percent of total billed charges,24% of total billed charges ,333,75,,,percent of total billed charges,75% of total billed charges ,333,75,,,percent of total billed charges,75% of total billed charges ,355.2,80,,,percent of total billed charges,80% of total billed charges ,107.63,24.24,,,percent of total billed charges,24.24% of total billed charges ,223.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,333,75,,,percent of total billed charges,75% of total billed charges ,108.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,119.26,26.86,,,percent of total billed charges,26.86% of total billed charges,106.56,24,,,percent of total billed charges,24% of total billed charges ,138.53,31.2,,,percent of total billed charges,31.2% of total billed charges,355.2,80,,,percent of total billed charges,80% of total billed charges,106.56,24,,,percent of total billed charges,24% of total billed charges ,106.56,24,,,percent of total billed charges,24% of total billed charges ,106.56,355.2,
SEROQUEL (QUETIAPINE) 200MG TAB,7049082,CDM,250,RC,,,Outpatient,,,74,37,,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,55.5,75,,,percent of total billed charges,75% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,59.2,80,,,percent of total billed charges,80% of total billed charges ,17.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,18.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,23.09,31.2,,,percent of total billed charges,31.2% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,59.2,
ZYRTEC (CETIRIZINE) 10MG TAB,7049134,CDM,250,RC,,,Outpatient,,,23.5,11.75,,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,18.8,80,,,percent of total billed charges,80% of total billed charges ,5.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,7.33,31.2,,,percent of total billed charges,31.2% of total billed charges,18.8,80,,,percent of total billed charges,80% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,18.8,
TRICOR (FENOFIBRATE) 145MG TAB,7049186,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ZZZHECTEROL (DOXERCALCIFEROL) 0.5MCG CAP,7049244,CDM,250,RC,,,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
MARCAINE (BUPIVICAINE) 0.75% 10ML INJ,7049292,CDM,250,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
LYRICA (PREGABALIN) 25MG CAP,7049344,CDM,250,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
ZZZZOCOR (SIMVASTATIN) 40MG TAB,7049397,CDM,250,RC,,,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
ZZZNF-AMARYL (GLIMEPIRIDE) 4MG TAB,7049501,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
ZESTRIL (LISINOPRIL) 20MG TAB,7049502,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
REQUIP (ROPINIROLE) 0.25MG TAB,7049712,CDM,250,RC,,,Outpatient,,,28,14,,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,22.4,80,,,percent of total billed charges,80% of total billed charges ,6.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,8.74,31.2,,,percent of total billed charges,31.2% of total billed charges,22.4,80,,,percent of total billed charges,80% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,22.4,
ZITHROMAX (AZITHROMY) 200MG/5ML SUS,7049921,CDM,250,RC,,,Outpatient,,,178,89,,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,142.4,
FOLIC ACID (FOLATE) 50MG/10ML VIAL,7050079,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
PULMICORT (BUDESONIDE) 0.5MG/2ML NEB,7050132,CDM,250,RC,,,Outpatient,,,65,32.5,,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,52,80,,,percent of total billed charges,80% of total billed charges ,15.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,15.6,24,,,percent of total billed charges,24% of total billed charges ,20.28,31.2,,,percent of total billed charges,31.2% of total billed charges,52,80,,,percent of total billed charges,80% of total billed charges,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,52,
ROBITUSSIN AC (GUA/COD) 100-10MG/5ML,7050236,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
DURAGESIC (FENTANYL) 12MCG/HR PTCH,7050289,CDM,250,RC,,,Outpatient,,,109,54.5,,29.28,26.86,,,percent of total billed charges,26.86% of total billed charges,81.75,75,,,percent of total billed charges,75% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,26.16,24,,,percent of total billed charges,24% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,87.2,80,,,percent of total billed charges,80% of total billed charges ,26.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,54.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,81.75,75,,,percent of total billed charges,75% of total billed charges ,26.68,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.28,26.86,,,percent of total billed charges,26.86% of total billed charges,26.16,24,,,percent of total billed charges,24% of total billed charges ,34.01,31.2,,,percent of total billed charges,31.2% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,26.16,24,,,percent of total billed charges,24% of total billed charges ,26.16,24,,,percent of total billed charges,24% of total billed charges ,26.16,87.2,
KETALAR (KETAMINE) 500MG/10ML INJ,7050342,CDM,636,RC,J3490,HCPCS,Outpatient,,,40,20,,10.74,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32,80,,,percent of total billed charges,80% of total billed charges ,9.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,9.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.74,26.86,,,percent of total billed charges,26.86% of total billed charges,9.6,24,,,percent of total billed charges,24% of total billed charges ,12.48,31.2,,,percent of total billed charges,31.2% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,9.6,24,,,percent of total billed charges,24% of total billed charges ,9.6,24,,,percent of total billed charges,24% of total billed charges ,9.6,32,
LYRICA (PREGABALIN) 75MG CAP,7050394,CDM,250,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
CYMBALTA (DULOXETINE) 30MG CAP,7050447,CDM,250,RC,,,Outpatient,,,16,8,,4.3,26.86,,,percent of total billed charges,26.86% of total billed charges,12,75,,,percent of total billed charges,75% of total billed charges ,12,75,,,percent of total billed charges,75% of total billed charges ,3.84,24,,,percent of total billed charges,24% of total billed charges ,12,75,,,percent of total billed charges,75% of total billed charges ,12,75,,,percent of total billed charges,75% of total billed charges ,12.8,80,,,percent of total billed charges,80% of total billed charges ,3.88,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,12,75,,,percent of total billed charges,75% of total billed charges ,3.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.3,26.86,,,percent of total billed charges,26.86% of total billed charges,3.84,24,,,percent of total billed charges,24% of total billed charges ,4.99,31.2,,,percent of total billed charges,31.2% of total billed charges,12.8,80,,,percent of total billed charges,80% of total billed charges,3.84,24,,,percent of total billed charges,24% of total billed charges ,3.84,24,,,percent of total billed charges,24% of total billed charges ,3.84,12.8,
NICODERM (NICOTINE) 7MG/24HR PATCH,7050513,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
NICODERM (NICOTINE) 14MG/24HR PATCH,7050514,CDM,250,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
NICODERM (NICOTINE) 21MG/24HR PATCH,7050515,CDM,250,RC,,,Outpatient,,,23.5,11.75,,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,18.8,80,,,percent of total billed charges,80% of total billed charges ,5.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,7.33,31.2,,,percent of total billed charges,31.2% of total billed charges,18.8,80,,,percent of total billed charges,80% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,18.8,
PROVIGIL (MODAFINIL) 100MG TAB,7050549,CDM,250,RC,,,Outpatient,,,138,69,,37.07,26.86,,,percent of total billed charges,26.86% of total billed charges,103.5,75,,,percent of total billed charges,75% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,33.12,24,,,percent of total billed charges,24% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,110.4,80,,,percent of total billed charges,80% of total billed charges ,33.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,69.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,103.5,75,,,percent of total billed charges,75% of total billed charges ,33.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.07,26.86,,,percent of total billed charges,26.86% of total billed charges,33.12,24,,,percent of total billed charges,24% of total billed charges ,43.06,31.2,,,percent of total billed charges,31.2% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,33.12,24,,,percent of total billed charges,24% of total billed charges ,33.12,24,,,percent of total billed charges,24% of total billed charges ,33.12,110.4,
THIAMINE 200MG/2ML VIAL,7050550,CDM,636,RC,J3411,HCPCS,Outpatient,,,72,36,,19.34,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.34,26.86,,,percent of total billed charges,26.86% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,57.6,
ZZZFERROUS SUL 300MG (60MG IRON)/5ML OR,7050567,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
MARCAINE (BUPIVACAINE) 0.25% 10ML INJ,7050602,CDM,250,RC,,,Outpatient,,,40,20,,10.74,26.86,,,percent of total billed charges,26.86% of total billed charges,30,75,,,percent of total billed charges,75% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,9.6,24,,,percent of total billed charges,24% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,32,80,,,percent of total billed charges,80% of total billed charges ,9.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,9.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.74,26.86,,,percent of total billed charges,26.86% of total billed charges,9.6,24,,,percent of total billed charges,24% of total billed charges ,12.48,31.2,,,percent of total billed charges,31.2% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,9.6,24,,,percent of total billed charges,24% of total billed charges ,9.6,24,,,percent of total billed charges,24% of total billed charges ,9.6,32,
ZZZBENICAR (OLMESARTAN MED) 40MG TAB,7050604,CDM,250,RC,,,Outpatient,,,54.5,27.25,,14.64,26.86,,,percent of total billed charges,26.86% of total billed charges,40.88,75,,,percent of total billed charges,75% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,13.08,24,,,percent of total billed charges,24% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,43.6,80,,,percent of total billed charges,80% of total billed charges ,13.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,27.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,13.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.64,26.86,,,percent of total billed charges,26.86% of total billed charges,13.08,24,,,percent of total billed charges,24% of total billed charges ,17,31.2,,,percent of total billed charges,31.2% of total billed charges,43.6,80,,,percent of total billed charges,80% of total billed charges,13.08,24,,,percent of total billed charges,24% of total billed charges ,13.08,24,,,percent of total billed charges,24% of total billed charges ,13.08,43.6,
ZZZRAZADYNE (GALANTAMINE) 4MG TAB,7050654,CDM,250,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
ZZZVIGAMOX (MOXIFLOXACIN) 0.5% OPT SOL,7050655,CDM,250,RC,,,Outpatient,,,791,395.5,,212.46,26.86,,,percent of total billed charges,26.86% of total billed charges,593.25,75,,,percent of total billed charges,75% of total billed charges ,593.25,75,,,percent of total billed charges,75% of total billed charges ,189.84,24,,,percent of total billed charges,24% of total billed charges ,593.25,75,,,percent of total billed charges,75% of total billed charges ,593.25,75,,,percent of total billed charges,75% of total billed charges ,632.8,80,,,percent of total billed charges,80% of total billed charges ,191.74,24.24,,,percent of total billed charges,24.24% of total billed charges ,398.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,593.25,75,,,percent of total billed charges,75% of total billed charges ,193.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,212.46,26.86,,,percent of total billed charges,26.86% of total billed charges,189.84,24,,,percent of total billed charges,24% of total billed charges ,246.79,31.2,,,percent of total billed charges,31.2% of total billed charges,632.8,80,,,percent of total billed charges,80% of total billed charges,189.84,24,,,percent of total billed charges,24% of total billed charges ,189.84,24,,,percent of total billed charges,24% of total billed charges ,189.84,632.8,
CLEOCIN 300MG/2ML INJ VIAL,7050707,CDM,250,RC,,,Outpatient,,,50.5,25.25,,13.56,26.86,,,percent of total billed charges,26.86% of total billed charges,37.88,75,,,percent of total billed charges,75% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,12.12,24,,,percent of total billed charges,24% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,40.4,80,,,percent of total billed charges,80% of total billed charges ,12.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.88,75,,,percent of total billed charges,75% of total billed charges ,12.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.56,26.86,,,percent of total billed charges,26.86% of total billed charges,12.12,24,,,percent of total billed charges,24% of total billed charges ,15.76,31.2,,,percent of total billed charges,31.2% of total billed charges,40.4,80,,,percent of total billed charges,80% of total billed charges,12.12,24,,,percent of total billed charges,24% of total billed charges ,12.12,24,,,percent of total billed charges,24% of total billed charges ,12.12,40.4,
ZZZADVAIR (FLUT/SALM) 500/50 DISKUS,7050759,CDM,250,RC,,,Outpatient,,,1118.5,559.25,,300.43,26.86,,,percent of total billed charges,26.86% of total billed charges,838.88,75,,,percent of total billed charges,75% of total billed charges ,838.88,75,,,percent of total billed charges,75% of total billed charges ,268.44,24,,,percent of total billed charges,24% of total billed charges ,838.88,75,,,percent of total billed charges,75% of total billed charges ,838.88,75,,,percent of total billed charges,75% of total billed charges ,894.8,80,,,percent of total billed charges,80% of total billed charges ,271.12,24.24,,,percent of total billed charges,24.24% of total billed charges ,563.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,838.88,75,,,percent of total billed charges,75% of total billed charges ,273.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,300.43,26.86,,,percent of total billed charges,26.86% of total billed charges,268.44,24,,,percent of total billed charges,24% of total billed charges ,348.97,31.2,,,percent of total billed charges,31.2% of total billed charges,894.8,80,,,percent of total billed charges,80% of total billed charges,268.44,24,,,percent of total billed charges,24% of total billed charges ,268.44,24,,,percent of total billed charges,24% of total billed charges ,268.44,894.8,
ZZZCIPROFLOXACIN 400MG/40ML VIAL,7050812,CDM,636,RC,J0744,HCPCS,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ZZZSTARLIX (NATEGLINIDE) 60MG TAB,7050864,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
VERSED (MIDAZOLAM) 2MG/2ML VIAL INJ,7050865,CDM,636,RC,J2250,HCPCS,Outpatient,,,16.5,8.25,,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,0.14,13.2,
ZZZSYNTHROID (LEVOTHYROXINE) 112MCG TB,7050969,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
SKELAXIN (METAXALONE) 800MG TAB,7050970,CDM,250,RC,,,Outpatient,,,38,19,,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,30.4,80,,,percent of total billed charges,80% of total billed charges ,9.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.15,50.4,,,percent of total billed charges,50.4% of total billed charges ,28.5,75,,,percent of total billed charges,75% of total billed charges ,9.3,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.21,26.86,,,percent of total billed charges,26.86% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,11.86,31.2,,,percent of total billed charges,31.2% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,24,,,percent of total billed charges,24% of total billed charges ,9.12,30.4,
D5W (DEXTROSE 5% WATER) 250ML IVPB,7051020,CDM,636,RC,J7060,HCPCS,Outpatient,,,37,18.5,,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.88,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,1.93,29.6,
ROBINUL (GLYCOPYRROLATE) 1MG/5ML INJ,7051022,CDM,250,RC,,,Outpatient,,,275,137.5,,73.87,26.86,,,percent of total billed charges,26.86% of total billed charges,206.25,75,,,percent of total billed charges,75% of total billed charges ,206.25,75,,,percent of total billed charges,75% of total billed charges ,66,24,,,percent of total billed charges,24% of total billed charges ,206.25,75,,,percent of total billed charges,75% of total billed charges ,206.25,75,,,percent of total billed charges,75% of total billed charges ,220,80,,,percent of total billed charges,80% of total billed charges ,66.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,138.6,50.4,,,percent of total billed charges,50.4% of total billed charges ,206.25,75,,,percent of total billed charges,75% of total billed charges ,67.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,73.87,26.86,,,percent of total billed charges,26.86% of total billed charges,66,24,,,percent of total billed charges,24% of total billed charges ,85.8,31.2,,,percent of total billed charges,31.2% of total billed charges,220,80,,,percent of total billed charges,80% of total billed charges,66,24,,,percent of total billed charges,24% of total billed charges ,66,24,,,percent of total billed charges,24% of total billed charges ,66,220,
ZZZD20W (DEXTROSE 20% WATER) 500ML IV,7051034,CDM,636,RC,,,Outpatient,,,78.5,39.25,,21.09,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.8,80,,,percent of total billed charges,80% of total billed charges ,19.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.88,75,,,percent of total billed charges,75% of total billed charges ,19.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.09,26.86,,,percent of total billed charges,26.86% of total billed charges,18.84,24,,,percent of total billed charges,24% of total billed charges ,24.49,31.2,,,percent of total billed charges,31.2% of total billed charges,62.8,80,,,percent of total billed charges,80% of total billed charges,18.84,24,,,percent of total billed charges,24% of total billed charges ,18.84,24,,,percent of total billed charges,24% of total billed charges ,18.84,62.8,
ZZZD70W (DEXTROSE 70% WATER) 2000ML IV,7051039,CDM,636,RC,J7799,HCPCS,Outpatient,,,104,52,,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.96,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,83.2,80,,,percent of total billed charges,80% of total billed charges ,25.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,25.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,32.45,31.2,,,percent of total billed charges,31.2% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,83.2,
ZZZPROCALAMINE (AA 3%/ELECT) 1000ML,7051046,CDM,250,RC,B4168,HCPCS,Outpatient,,,157.5,78.75,,42.3,26.86,,,percent of total billed charges,26.86% of total billed charges,118.13,75,,,percent of total billed charges,75% of total billed charges ,118.13,75,,,percent of total billed charges,75% of total billed charges ,37.8,24,,,percent of total billed charges,24% of total billed charges ,118.13,75,,,percent of total billed charges,75% of total billed charges ,118.13,75,,,percent of total billed charges,75% of total billed charges ,126,80,,,percent of total billed charges,80% of total billed charges ,38.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,79.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,118.13,75,,,percent of total billed charges,75% of total billed charges ,38.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,42.3,26.86,,,percent of total billed charges,26.86% of total billed charges,37.8,24,,,percent of total billed charges,24% of total billed charges ,49.14,31.2,,,percent of total billed charges,31.2% of total billed charges,126,80,,,percent of total billed charges,80% of total billed charges,37.8,24,,,percent of total billed charges,24% of total billed charges ,37.8,24,,,percent of total billed charges,24% of total billed charges ,37.8,126,
D5+NS 1000ML IV BAG,7051050,CDM,636,RC,J7042,HCPCS,Outpatient,,,64,32,,1.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,1.59,51.2,
HYPERTONIC (3% SOD CHL) 500ML IV,7051085,CDM,250,RC,,,Outpatient,,,58.5,29.25,,15.71,26.86,,,percent of total billed charges,26.86% of total billed charges,43.88,75,,,percent of total billed charges,75% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,46.8,80,,,percent of total billed charges,80% of total billed charges ,14.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.88,75,,,percent of total billed charges,75% of total billed charges ,14.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.71,26.86,,,percent of total billed charges,26.86% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,18.25,31.2,,,percent of total billed charges,31.2% of total billed charges,46.8,80,,,percent of total billed charges,80% of total billed charges,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,24,,,percent of total billed charges,24% of total billed charges ,14.04,46.8,
NS (0.9% SOD CHLORIDE) 100ML PB,7051090,CDM,636,RC,J7050,HCPCS,Outpatient,,,44.5,22.25,,0.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.6,80,,,percent of total billed charges,80% of total billed charges ,10.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,10.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.68,24,,,percent of total billed charges,24% of total billed charges ,13.88,31.2,,,percent of total billed charges,31.2% of total billed charges,35.6,80,,,percent of total billed charges,80% of total billed charges,10.68,24,,,percent of total billed charges,24% of total billed charges ,10.68,24,,,percent of total billed charges,24% of total billed charges ,0.67,35.6,
D5LR 1000ML IV BAG,7051110,CDM,636,RC,J7120,HCPCS,Outpatient,,,64,32,,2.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,2.59,51.2,
LACTATED RINGERS IV 1000ML,7051130,CDM,636,RC,J7120,HCPCS,Outpatient,,,64,32,,2.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,2.59,51.2,
D5+NS+KCL 20MEQ 1000ML IV,7051151,CDM,636,RC,J3480,HCPCS,Outpatient,,,66,33,,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.8,80,,,percent of total billed charges,80% of total billed charges ,16,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,16.16,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.84,24,,,percent of total billed charges,24% of total billed charges ,20.59,31.2,,,percent of total billed charges,31.2% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,0.12,52.8,
D5+1/2NS 1000ML IV BAG,7051170,CDM,636,RC,J7042,HCPCS,Outpatient,,,64,32,,1.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,1.59,51.2,
D10W (DEXTROSE 10% WATER) 1000ML IV,7051190,CDM,258,RC,,,Outpatient,,,64,32,,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,51.2,
"ZZZHEPARIN-D5W 25,000 UNIT/500ML DRIP",7051198,CDM,636,RC,J1644,HCPCS,Outpatient,,,52.5,26.25,,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.6,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42,80,,,percent of total billed charges,80% of total billed charges ,12.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.46,50.4,,,percent of total billed charges,50.4% of total billed charges ,39.38,75,,,percent of total billed charges,75% of total billed charges ,12.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.6,24,,,percent of total billed charges,24% of total billed charges ,16.38,31.2,,,percent of total billed charges,31.2% of total billed charges,42,80,,,percent of total billed charges,80% of total billed charges,12.6,24,,,percent of total billed charges,24% of total billed charges ,12.6,24,,,percent of total billed charges,24% of total billed charges ,0.27,42,
1/2NS (0.45% SOD CHLORIDE) 1000ML,7051200,CDM,636,RC,J7030,HCPCS,Outpatient,,,64,32,,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,2.69,51.2,
D5+1/4NS 1000ML IV BAG,7051220,CDM,636,RC,J7042,HCPCS,Outpatient,,,64,32,,1.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,1.59,51.2,
LIPIDS 10% (LIPOSYN) 250ML IV,7051234,CDM,272,RC,B4185,HCPCS,Outpatient,,,66,33,,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,52.8,80,,,percent of total billed charges,80% of total billed charges ,16,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,16.16,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,20.59,31.2,,,percent of total billed charges,31.2% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,52.8,
LIPIDS 20% (LIPOSYN) 250ML IV,7051236,CDM,272,RC,B4185,HCPCS,Outpatient,,,248,124,,66.61,26.86,,,percent of total billed charges,26.86% of total billed charges,186,75,,,percent of total billed charges,75% of total billed charges ,186,75,,,percent of total billed charges,75% of total billed charges ,59.52,24,,,percent of total billed charges,24% of total billed charges ,186,75,,,percent of total billed charges,75% of total billed charges ,186,75,,,percent of total billed charges,75% of total billed charges ,198.4,80,,,percent of total billed charges,80% of total billed charges ,60.12,24.24,,,percent of total billed charges,24.24% of total billed charges ,124.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,186,75,,,percent of total billed charges,75% of total billed charges ,60.71,24.48,,,percent of total billed charges,24.48% of total billed charges ,66.61,26.86,,,percent of total billed charges,26.86% of total billed charges,59.52,24,,,percent of total billed charges,24% of total billed charges ,77.38,31.2,,,percent of total billed charges,31.2% of total billed charges,198.4,80,,,percent of total billed charges,80% of total billed charges,59.52,24,,,percent of total billed charges,24% of total billed charges ,59.52,24,,,percent of total billed charges,24% of total billed charges ,59.52,198.4,
HESPAN (HETASTARTCH 6%+NS) 500ML,7051240,CDM,250,RC,,,Outpatient,,,137,68.5,,36.8,26.86,,,percent of total billed charges,26.86% of total billed charges,102.75,75,,,percent of total billed charges,75% of total billed charges ,102.75,75,,,percent of total billed charges,75% of total billed charges ,32.88,24,,,percent of total billed charges,24% of total billed charges ,102.75,75,,,percent of total billed charges,75% of total billed charges ,102.75,75,,,percent of total billed charges,75% of total billed charges ,109.6,80,,,percent of total billed charges,80% of total billed charges ,33.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,69.05,50.4,,,percent of total billed charges,50.4% of total billed charges ,102.75,75,,,percent of total billed charges,75% of total billed charges ,33.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.8,26.86,,,percent of total billed charges,26.86% of total billed charges,32.88,24,,,percent of total billed charges,24% of total billed charges ,42.74,31.2,,,percent of total billed charges,31.2% of total billed charges,109.6,80,,,percent of total billed charges,80% of total billed charges,32.88,24,,,percent of total billed charges,24% of total billed charges ,32.88,24,,,percent of total billed charges,24% of total billed charges ,32.88,109.6,
MANNITOL 20%  IV BAG,7051256,CDM,636,RC,J2150,HCPCS,Outpatient,,,139,69.5,,2.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,111.2,80,,,percent of total billed charges,80% of total billed charges ,33.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,70.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,104.25,75,,,percent of total billed charges,75% of total billed charges ,34.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.36,24,,,percent of total billed charges,24% of total billed charges ,43.37,31.2,,,percent of total billed charges,31.2% of total billed charges,111.2,80,,,percent of total billed charges,80% of total billed charges,33.36,24,,,percent of total billed charges,24% of total billed charges ,33.36,24,,,percent of total billed charges,24% of total billed charges ,2.6,111.2,
DOPAMINE 800MG/250ML IV DRIP,7051260,CDM,636,RC,J1265,HCPCS,Outpatient,,,118,59,,31.69,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,94.4,80,,,percent of total billed charges,80% of total billed charges ,28.6,24.24,,,percent of total billed charges,24.24% of total billed charges ,59.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,88.5,75,,,percent of total billed charges,75% of total billed charges ,28.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.69,26.86,,,percent of total billed charges,26.86% of total billed charges,28.32,24,,,percent of total billed charges,24% of total billed charges ,36.82,31.2,,,percent of total billed charges,31.2% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,28.32,24,,,percent of total billed charges,24% of total billed charges ,28.32,24,,,percent of total billed charges,24% of total billed charges ,28.32,94.4,
D5+0.45%NS+KCL 20MEQ 1000ML IV,7051270,CDM,636,RC,J3480,HCPCS,Outpatient,,,64,32,,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,0.12,51.2,
D5+0.45%NS+KCL 40MEQ 1000ML IV,7051280,CDM,636,RC,J3480,HCPCS,Outpatient,,,64,32,,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,0.12,51.2,
WELCHOL (COLESEVELAM) 625MG TAB,7051285,CDM,250,RC,,,Outpatient,,,30,15,,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,24,80,,,percent of total billed charges,80% of total billed charges ,7.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,,,percent of total billed charges,31.2% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,
NS (0.9% SOD CHLORIDE) 1000ML IRR,7051310,CDM,258,RC,,,Outpatient,,,36,18,,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,28.8,80,,,percent of total billed charges,80% of total billed charges ,8.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,11.23,31.2,,,percent of total billed charges,31.2% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,28.8,
STERILE WATER IRRIGATION 1000ML BOT,7051320,CDM,250,RC,,,Outpatient,,,64,32,,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,51.2,
IMDUR (ISOSORBIDE MON) 30MG TAB,7051390,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
GLUCOPHAGE XR (METFORMIN ER) 500MG TB,7051494,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
NAMENDA (MEMANTINE HCL) 10MG TAB,7051600,CDM,250,RC,,,Outpatient,,,39,19.5,,10.48,26.86,,,percent of total billed charges,26.86% of total billed charges,29.25,75,,,percent of total billed charges,75% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,9.36,24,,,percent of total billed charges,24% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,31.2,80,,,percent of total billed charges,80% of total billed charges ,9.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,9.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.48,26.86,,,percent of total billed charges,26.86% of total billed charges,9.36,24,,,percent of total billed charges,24% of total billed charges ,12.17,31.2,,,percent of total billed charges,31.2% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,9.36,24,,,percent of total billed charges,24% of total billed charges ,9.36,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,
ZETIA (EZETIMIBE) 10MG TAB,7051652,CDM,250,RC,,,Outpatient,,,62,31,,16.65,26.86,,,percent of total billed charges,26.86% of total billed charges,46.5,75,,,percent of total billed charges,75% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,14.88,24,,,percent of total billed charges,24% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,49.6,80,,,percent of total billed charges,80% of total billed charges ,15.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,15.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.65,26.86,,,percent of total billed charges,26.86% of total billed charges,14.88,24,,,percent of total billed charges,24% of total billed charges ,19.34,31.2,,,percent of total billed charges,31.2% of total billed charges,49.6,80,,,percent of total billed charges,80% of total billed charges,14.88,24,,,percent of total billed charges,24% of total billed charges ,14.88,24,,,percent of total billed charges,24% of total billed charges ,14.88,49.6,
AUGMENTIN XR (AMOX/CL) 1000/125 TAB,7051862,CDM,250,RC,,,Outpatient,,,44.5,22.25,,11.95,26.86,,,percent of total billed charges,26.86% of total billed charges,33.38,75,,,percent of total billed charges,75% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,10.68,24,,,percent of total billed charges,24% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,35.6,80,,,percent of total billed charges,80% of total billed charges ,10.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,10.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.95,26.86,,,percent of total billed charges,26.86% of total billed charges,10.68,24,,,percent of total billed charges,24% of total billed charges ,13.88,31.2,,,percent of total billed charges,31.2% of total billed charges,35.6,80,,,percent of total billed charges,80% of total billed charges,10.68,24,,,percent of total billed charges,24% of total billed charges ,10.68,24,,,percent of total billed charges,24% of total billed charges ,10.68,35.6,
ZZZMICARDIS (TELMISARTAN) 80MG TAB,7051914,CDM,250,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
ACTIVASE CATHFLO (ALTEPLASE) 2MG INJ,7052072,CDM,636,RC,J2997,HCPCS,Outpatient,,,813.5,406.75,,218.51,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,195.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,650.8,80,,,percent of total billed charges,80% of total billed charges ,197.19,24.24,,,percent of total billed charges,24.24% of total billed charges ,410,50.4,,,percent of total billed charges,50.4% of total billed charges ,610.13,75,,,percent of total billed charges,75% of total billed charges ,199.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,218.51,26.86,,,percent of total billed charges,26.86% of total billed charges,195.24,24,,,percent of total billed charges,24% of total billed charges ,253.81,31.2,,,percent of total billed charges,31.2% of total billed charges,650.8,80,,,percent of total billed charges,80% of total billed charges,195.24,24,,,percent of total billed charges,24% of total billed charges ,195.24,24,,,percent of total billed charges,24% of total billed charges ,195.24,650.8,
MACROBID (NITROFURANTOIN) 100MG CAP,7052177,CDM,250,RC,,,Outpatient,,,30,15,,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,24,80,,,percent of total billed charges,80% of total billed charges ,7.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,,,percent of total billed charges,31.2% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,
ZZZCORGARD (NADOLOL) 20MG TAB,7052230,CDM,250,RC,,,Outpatient,,,30,15,,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,24,80,,,percent of total billed charges,80% of total billed charges ,7.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,,,percent of total billed charges,31.2% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,
ABILIFY (ARIPIPRAZOLE) 10MG TAB,7052597,CDM,250,RC,,,Outpatient,,,166,83,,44.59,26.86,,,percent of total billed charges,26.86% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,132.8,80,,,percent of total billed charges,80% of total billed charges ,40.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,124.5,75,,,percent of total billed charges,75% of total billed charges ,40.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,44.59,26.86,,,percent of total billed charges,26.86% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,51.79,31.2,,,percent of total billed charges,31.2% of total billed charges,132.8,80,,,percent of total billed charges,80% of total billed charges,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,24,,,percent of total billed charges,24% of total billed charges ,39.84,132.8,
MAGIC MOUTHWASH (DIPH/NYST/HYD) 240ML,7052649,CDM,250,RC,,,Outpatient,,,180.5,90.25,,48.48,26.86,,,percent of total billed charges,26.86% of total billed charges,135.38,75,,,percent of total billed charges,75% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,43.32,24,,,percent of total billed charges,24% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,144.4,80,,,percent of total billed charges,80% of total billed charges ,43.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,90.97,50.4,,,percent of total billed charges,50.4% of total billed charges ,135.38,75,,,percent of total billed charges,75% of total billed charges ,44.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,48.48,26.86,,,percent of total billed charges,26.86% of total billed charges,43.32,24,,,percent of total billed charges,24% of total billed charges ,56.32,31.2,,,percent of total billed charges,31.2% of total billed charges,144.4,80,,,percent of total billed charges,80% of total billed charges,43.32,24,,,percent of total billed charges,24% of total billed charges ,43.32,24,,,percent of total billed charges,24% of total billed charges ,43.32,144.4,
ZZZDETROL LA (TOLTERODINE ER) 4MG CAP,7052754,CDM,250,RC,,,Outpatient,,,79.5,39.75,,21.35,26.86,,,percent of total billed charges,26.86% of total billed charges,59.63,75,,,percent of total billed charges,75% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,19.08,24,,,percent of total billed charges,24% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,63.6,80,,,percent of total billed charges,80% of total billed charges ,19.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,40.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,59.63,75,,,percent of total billed charges,75% of total billed charges ,19.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.35,26.86,,,percent of total billed charges,26.86% of total billed charges,19.08,24,,,percent of total billed charges,24% of total billed charges ,24.8,31.2,,,percent of total billed charges,31.2% of total billed charges,63.6,80,,,percent of total billed charges,80% of total billed charges,19.08,24,,,percent of total billed charges,24% of total billed charges ,19.08,24,,,percent of total billed charges,24% of total billed charges ,19.08,63.6,
RISPERDAL (RISPERIDONE) 0.5MG TAB,7052755,CDM,250,RC,,,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
PROTONIX (PANTOPRAZOLE) 40MG VIAL,7052807,CDM,636,RC,C9113,HCPCS,Outpatient,,,53.5,26.75,,14.37,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.8,80,,,percent of total billed charges,80% of total billed charges ,12.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,13.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.37,26.86,,,percent of total billed charges,26.86% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,16.69,31.2,,,percent of total billed charges,31.2% of total billed charges,42.8,80,,,percent of total billed charges,80% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,42.8,
LACTULOSE 20GM/30ML SOL UD,7052859,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZPRANDIN (REPAGLINIDE) 1MG TAB,7053017,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
TRAVATAN Z (TRAVOPROST 0.004%) OP SOL,7053070,CDM,250,RC,,,Outpatient,,,913.5,456.75,,245.37,26.86,,,percent of total billed charges,26.86% of total billed charges,685.13,75,,,percent of total billed charges,75% of total billed charges ,685.13,75,,,percent of total billed charges,75% of total billed charges ,219.24,24,,,percent of total billed charges,24% of total billed charges ,685.13,75,,,percent of total billed charges,75% of total billed charges ,685.13,75,,,percent of total billed charges,75% of total billed charges ,730.8,80,,,percent of total billed charges,80% of total billed charges ,221.43,24.24,,,percent of total billed charges,24.24% of total billed charges ,460.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,685.13,75,,,percent of total billed charges,75% of total billed charges ,223.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,245.37,26.86,,,percent of total billed charges,26.86% of total billed charges,219.24,24,,,percent of total billed charges,24% of total billed charges ,285.01,31.2,,,percent of total billed charges,31.2% of total billed charges,730.8,80,,,percent of total billed charges,80% of total billed charges,219.24,24,,,percent of total billed charges,24% of total billed charges ,219.24,24,,,percent of total billed charges,24% of total billed charges ,219.24,730.8,
ZZZCORLOPAM 10MG/ML INTRAVENOUS SOLUTION,7053174,CDM,250,RC,,,Outpatient,,,1385.5,692.75,,372.15,26.86,,,percent of total billed charges,26.86% of total billed charges,1039.13,75,,,percent of total billed charges,75% of total billed charges ,1039.13,75,,,percent of total billed charges,75% of total billed charges ,332.52,24,,,percent of total billed charges,24% of total billed charges ,1039.13,75,,,percent of total billed charges,75% of total billed charges ,1039.13,75,,,percent of total billed charges,75% of total billed charges ,1108.4,80,,,percent of total billed charges,80% of total billed charges ,335.85,24.24,,,percent of total billed charges,24.24% of total billed charges ,698.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,1039.13,75,,,percent of total billed charges,75% of total billed charges ,339.17,24.48,,,percent of total billed charges,24.48% of total billed charges ,372.15,26.86,,,percent of total billed charges,26.86% of total billed charges,332.52,24,,,percent of total billed charges,24% of total billed charges ,432.28,31.2,,,percent of total billed charges,31.2% of total billed charges,1108.4,80,,,percent of total billed charges,80% of total billed charges,332.52,24,,,percent of total billed charges,24% of total billed charges ,332.52,24,,,percent of total billed charges,24% of total billed charges ,332.52,1108.4,
PAXIL CR (PAROXETINE) 12.5MG TAB,7053227,CDM,250,RC,,,Outpatient,,,36,18,,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,28.8,80,,,percent of total billed charges,80% of total billed charges ,8.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,11.23,31.2,,,percent of total billed charges,31.2% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,28.8,
ZZZBENICAR (OLMESARTAN MED) 5MG TAB,7053280,CDM,250,RC,,,Outpatient,,,40,20,,10.74,26.86,,,percent of total billed charges,26.86% of total billed charges,30,75,,,percent of total billed charges,75% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,9.6,24,,,percent of total billed charges,24% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,32,80,,,percent of total billed charges,80% of total billed charges ,9.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,30,75,,,percent of total billed charges,75% of total billed charges ,9.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.74,26.86,,,percent of total billed charges,26.86% of total billed charges,9.6,24,,,percent of total billed charges,24% of total billed charges ,12.48,31.2,,,percent of total billed charges,31.2% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,9.6,24,,,percent of total billed charges,24% of total billed charges ,9.6,24,,,percent of total billed charges,24% of total billed charges ,9.6,32,
ZZZFOLTX (LEVOMEFALATE/CA/B) TAB,7053384,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
BACTROBAN (MUPIROCIN 2%) OINTMENT TUBE,7053385,CDM,250,RC,,,Outpatient,,,70,35,,18.8,26.86,,,percent of total billed charges,26.86% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,16.8,24,,,percent of total billed charges,24% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,56,80,,,percent of total billed charges,80% of total billed charges ,16.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,17.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.8,26.86,,,percent of total billed charges,26.86% of total billed charges,16.8,24,,,percent of total billed charges,24% of total billed charges ,21.84,31.2,,,percent of total billed charges,31.2% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,16.8,24,,,percent of total billed charges,24% of total billed charges ,16.8,24,,,percent of total billed charges,24% of total billed charges ,16.8,56,
GEODON (ZIPRASIDONE) 20MG CAP,7053542,CDM,250,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
RENAGEL (SEVELAMER HCL) 800MG TAB,7053647,CDM,250,RC,,,Outpatient,,,39,19.5,,10.48,26.86,,,percent of total billed charges,26.86% of total billed charges,29.25,75,,,percent of total billed charges,75% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,9.36,24,,,percent of total billed charges,24% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,31.2,80,,,percent of total billed charges,80% of total billed charges ,9.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,9.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.48,26.86,,,percent of total billed charges,26.86% of total billed charges,9.36,24,,,percent of total billed charges,24% of total billed charges ,12.17,31.2,,,percent of total billed charges,31.2% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,9.36,24,,,percent of total billed charges,24% of total billed charges ,9.36,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,
ZZZPROLIXIN (FLUPHENAZINE) 1MG TAB,7053804,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
MOBIC (MELOXICAM) 7.5MG TAB,7053909,CDM,250,RC,,,Outpatient,,,26,13,,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,20.8,
NF-ACCUPRIL (QUINAPRIL) 40MG TAB,7054119,CDM,250,RC,,,Outpatient,,,10.5,5.25,,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,8.4,80,,,percent of total billed charges,80% of total billed charges ,2.55,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,3.28,31.2,,,percent of total billed charges,31.2% of total billed charges,8.4,80,,,percent of total billed charges,80% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,8.4,
ZZZCOSOPT (DORZ/TIMOLOL) OPTH SOLN,7054120,CDM,250,RC,,,Outpatient,,,521,260.5,,139.94,26.86,,,percent of total billed charges,26.86% of total billed charges,390.75,75,,,percent of total billed charges,75% of total billed charges ,390.75,75,,,percent of total billed charges,75% of total billed charges ,125.04,24,,,percent of total billed charges,24% of total billed charges ,390.75,75,,,percent of total billed charges,75% of total billed charges ,390.75,75,,,percent of total billed charges,75% of total billed charges ,416.8,80,,,percent of total billed charges,80% of total billed charges ,126.29,24.24,,,percent of total billed charges,24.24% of total billed charges ,262.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,390.75,75,,,percent of total billed charges,75% of total billed charges ,127.54,24.48,,,percent of total billed charges,24.48% of total billed charges ,139.94,26.86,,,percent of total billed charges,26.86% of total billed charges,125.04,24,,,percent of total billed charges,24% of total billed charges ,162.55,31.2,,,percent of total billed charges,31.2% of total billed charges,416.8,80,,,percent of total billed charges,80% of total billed charges,125.04,24,,,percent of total billed charges,24% of total billed charges ,125.04,24,,,percent of total billed charges,24% of total billed charges ,125.04,416.8,
ZZZOPTIVAR (AZELASTINE) 0.05% OPTH SOL,7054225,CDM,250,RC,,,Outpatient,,,445,222.5,,119.53,26.86,,,percent of total billed charges,26.86% of total billed charges,333.75,75,,,percent of total billed charges,75% of total billed charges ,333.75,75,,,percent of total billed charges,75% of total billed charges ,106.8,24,,,percent of total billed charges,24% of total billed charges ,333.75,75,,,percent of total billed charges,75% of total billed charges ,333.75,75,,,percent of total billed charges,75% of total billed charges ,356,80,,,percent of total billed charges,80% of total billed charges ,107.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,224.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,333.75,75,,,percent of total billed charges,75% of total billed charges ,108.94,24.48,,,percent of total billed charges,24.48% of total billed charges ,119.53,26.86,,,percent of total billed charges,26.86% of total billed charges,106.8,24,,,percent of total billed charges,24% of total billed charges ,138.84,31.2,,,percent of total billed charges,31.2% of total billed charges,356,80,,,percent of total billed charges,80% of total billed charges,106.8,24,,,percent of total billed charges,24% of total billed charges ,106.8,24,,,percent of total billed charges,24% of total billed charges ,106.8,356,
ZZZALLEGRA-D 12HR (FEX/PSEUD) TAB,7054330,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
COLACE (DOCUSATE SOD) 50MG/5ML LIQ,7054434,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZALLEGRA (FEXOFENADINE) 60MG TAB,7054435,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
STERILE WATER INH / INJ 1000ML,7054487,CDM,258,RC,,,Outpatient,,,64,32,,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.19,26.86,,,percent of total billed charges,26.86% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,51.2,
MIRALAX (POLYETHYLENE GLY) 17GM PK,7054692,CDM,250,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
CATAPRES TTS-1(CLONIDINE) 0.1MG PAT,7055000,CDM,250,RC,,,Outpatient,,,170,85,,45.66,26.86,,,percent of total billed charges,26.86% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,40.8,24,,,percent of total billed charges,24% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,136,80,,,percent of total billed charges,80% of total billed charges ,41.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,85.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,127.5,75,,,percent of total billed charges,75% of total billed charges ,41.62,24.48,,,percent of total billed charges,24.48% of total billed charges ,45.66,26.86,,,percent of total billed charges,26.86% of total billed charges,40.8,24,,,percent of total billed charges,24% of total billed charges ,53.04,31.2,,,percent of total billed charges,31.2% of total billed charges,136,80,,,percent of total billed charges,80% of total billed charges,40.8,24,,,percent of total billed charges,24% of total billed charges ,40.8,24,,,percent of total billed charges,24% of total billed charges ,40.8,136,
CATAPRES TTS-2(CLONIDINE) 0.2MG PAT,7055010,CDM,250,RC,,,Outpatient,,,87.5,43.75,,23.5,26.86,,,percent of total billed charges,26.86% of total billed charges,65.63,75,,,percent of total billed charges,75% of total billed charges ,65.63,75,,,percent of total billed charges,75% of total billed charges ,21,24,,,percent of total billed charges,24% of total billed charges ,65.63,75,,,percent of total billed charges,75% of total billed charges ,65.63,75,,,percent of total billed charges,75% of total billed charges ,70,80,,,percent of total billed charges,80% of total billed charges ,21.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,44.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,65.63,75,,,percent of total billed charges,75% of total billed charges ,21.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.5,26.86,,,percent of total billed charges,26.86% of total billed charges,21,24,,,percent of total billed charges,24% of total billed charges ,27.3,31.2,,,percent of total billed charges,31.2% of total billed charges,70,80,,,percent of total billed charges,80% of total billed charges,21,24,,,percent of total billed charges,24% of total billed charges ,21,24,,,percent of total billed charges,24% of total billed charges ,21,70,
ZZZCATAPRES TTS-3(CLONIDINE) 0.3MG PAT,7055020,CDM,250,RC,,,Outpatient,,,382,191,,102.61,26.86,,,percent of total billed charges,26.86% of total billed charges,286.5,75,,,percent of total billed charges,75% of total billed charges ,286.5,75,,,percent of total billed charges,75% of total billed charges ,91.68,24,,,percent of total billed charges,24% of total billed charges ,286.5,75,,,percent of total billed charges,75% of total billed charges ,286.5,75,,,percent of total billed charges,75% of total billed charges ,305.6,80,,,percent of total billed charges,80% of total billed charges ,92.6,24.24,,,percent of total billed charges,24.24% of total billed charges ,192.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,286.5,75,,,percent of total billed charges,75% of total billed charges ,93.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,102.61,26.86,,,percent of total billed charges,26.86% of total billed charges,91.68,24,,,percent of total billed charges,24% of total billed charges ,119.18,31.2,,,percent of total billed charges,31.2% of total billed charges,305.6,80,,,percent of total billed charges,80% of total billed charges,91.68,24,,,percent of total billed charges,24% of total billed charges ,91.68,24,,,percent of total billed charges,24% of total billed charges ,91.68,305.6,
NITROGLYCERIN 0.4MG SUBL TAB,7055030,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
NITRO-DUR (NITROGLYCERIN) 0.4MG PATCH,7055040,CDM,250,RC,,,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ZZZNITRO-DUR (NITROGLYCERIN) 0.1MG PATCH,7055050,CDM,250,RC,,,Outpatient,,,10.5,5.25,,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,8.4,80,,,percent of total billed charges,80% of total billed charges ,2.55,24.24,,,percent of total billed charges,24.24% of total billed charges ,5.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,7.88,75,,,percent of total billed charges,75% of total billed charges ,2.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.82,26.86,,,percent of total billed charges,26.86% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,3.28,31.2,,,percent of total billed charges,31.2% of total billed charges,8.4,80,,,percent of total billed charges,80% of total billed charges,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,24,,,percent of total billed charges,24% of total billed charges ,2.52,8.4,
NITRO-DUR (NITROGLYCERIN) 0.2MG PATCH,7055060,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
0.45% SOD CHL+KCL 20MEQ 1000ML IV,7055065,CDM,636,RC,J3480,HCPCS,Outpatient,,,64,32,,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,0.12,51.2,
TRANSDERM-SCOP 1MG TRANSDERMAL 72 HOUR,7055082,CDM,250,RC,,,Outpatient,,,134,67,,35.99,26.86,,,percent of total billed charges,26.86% of total billed charges,100.5,75,,,percent of total billed charges,75% of total billed charges ,100.5,75,,,percent of total billed charges,75% of total billed charges ,32.16,24,,,percent of total billed charges,24% of total billed charges ,100.5,75,,,percent of total billed charges,75% of total billed charges ,100.5,75,,,percent of total billed charges,75% of total billed charges ,107.2,80,,,percent of total billed charges,80% of total billed charges ,32.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,67.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,100.5,75,,,percent of total billed charges,75% of total billed charges ,32.8,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.99,26.86,,,percent of total billed charges,26.86% of total billed charges,32.16,24,,,percent of total billed charges,24% of total billed charges ,41.81,31.2,,,percent of total billed charges,31.2% of total billed charges,107.2,80,,,percent of total billed charges,80% of total billed charges,32.16,24,,,percent of total billed charges,24% of total billed charges ,32.16,24,,,percent of total billed charges,24% of total billed charges ,32.16,107.2,
NS (0.9% SOD CHLORIDE) 3ML NEB,7055104,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
PROVENTIL INH (ALBUTEROL) 2.5MG/3ML UD,7055110,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZTRACE ELEMENTS 10ML VIAL,7055170,CDM,250,RC,B4216,HCPCS,Outpatient,,,62,31,,16.65,26.86,,,percent of total billed charges,26.86% of total billed charges,46.5,75,,,percent of total billed charges,75% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,14.88,24,,,percent of total billed charges,24% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,49.6,80,,,percent of total billed charges,80% of total billed charges ,15.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,15.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.65,26.86,,,percent of total billed charges,26.86% of total billed charges,14.88,24,,,percent of total billed charges,24% of total billed charges ,19.34,31.2,,,percent of total billed charges,31.2% of total billed charges,49.6,80,,,percent of total billed charges,80% of total billed charges,14.88,24,,,percent of total billed charges,24% of total billed charges ,14.88,24,,,percent of total billed charges,24% of total billed charges ,14.88,49.6,
TOPICORT (DESOXIMETA) 0.25% OINT 15GM,7055180,CDM,250,RC,,,Outpatient,,,435.5,217.75,,116.98,26.86,,,percent of total billed charges,26.86% of total billed charges,326.63,75,,,percent of total billed charges,75% of total billed charges ,326.63,75,,,percent of total billed charges,75% of total billed charges ,104.52,24,,,percent of total billed charges,24% of total billed charges ,326.63,75,,,percent of total billed charges,75% of total billed charges ,326.63,75,,,percent of total billed charges,75% of total billed charges ,348.4,80,,,percent of total billed charges,80% of total billed charges ,105.57,24.24,,,percent of total billed charges,24.24% of total billed charges ,219.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,326.63,75,,,percent of total billed charges,75% of total billed charges ,106.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,116.98,26.86,,,percent of total billed charges,26.86% of total billed charges,104.52,24,,,percent of total billed charges,24% of total billed charges ,135.88,31.2,,,percent of total billed charges,31.2% of total billed charges,348.4,80,,,percent of total billed charges,80% of total billed charges,104.52,24,,,percent of total billed charges,24% of total billed charges ,104.52,24,,,percent of total billed charges,24% of total billed charges ,104.52,348.4,
ALBUMIN 25% 100ML IV,7055229,CDM,636,RC,P9046,HCPCS,Outpatient,,,475,237.5,,21.23,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,114,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,380,80,,,percent of total billed charges,80% of total billed charges ,115.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,239.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,356.25,75,,,percent of total billed charges,75% of total billed charges ,116.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.23,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,114,24,,,percent of total billed charges,24% of total billed charges ,148.2,31.2,,,percent of total billed charges,31.2% of total billed charges,380,80,,,percent of total billed charges,80% of total billed charges,114,24,,,percent of total billed charges,24% of total billed charges ,114,24,,,percent of total billed charges,24% of total billed charges ,21.23,380,
ZZZHEPARIN FLUSH 100 UNIT/ML 5ML INJ,7055235,CDM,636,RC,J1642,HCPCS,Outpatient,,,23.5,11.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.8,80,,,percent of total billed charges,80% of total billed charges ,5.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,,,,,Other,Not Separately reimbursable,5.64,24,,,percent of total billed charges,24% of total billed charges ,7.33,31.2,,,percent of total billed charges,31.2% of total billed charges,18.8,80,,,percent of total billed charges,80% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,18.8,
STERILE WATER FOR INJ 10ML,7055300,CDM,272,RC,,,Outpatient,,,15,7.5,,4.03,26.86,,,percent of total billed charges,26.86% of total billed charges,11.25,75,,,percent of total billed charges,75% of total billed charges ,11.25,75,,,percent of total billed charges,75% of total billed charges ,3.6,24,,,percent of total billed charges,24% of total billed charges ,11.25,75,,,percent of total billed charges,75% of total billed charges ,11.25,75,,,percent of total billed charges,75% of total billed charges ,12,80,,,percent of total billed charges,80% of total billed charges ,3.64,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.25,75,,,percent of total billed charges,75% of total billed charges ,3.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.03,26.86,,,percent of total billed charges,26.86% of total billed charges,3.6,24,,,percent of total billed charges,24% of total billed charges ,4.68,31.2,,,percent of total billed charges,31.2% of total billed charges,12,80,,,percent of total billed charges,80% of total billed charges,3.6,24,,,percent of total billed charges,24% of total billed charges ,3.6,24,,,percent of total billed charges,24% of total billed charges ,3.6,12,
SOIDUM CHLORIDE  4MEQ/ML VL,7055330,CDM,250,RC,,,Outpatient,,,36,18,,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,28.8,80,,,percent of total billed charges,80% of total billed charges ,8.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,11.23,31.2,,,percent of total billed charges,31.2% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,28.8,
LIDOCAINE 2% 100MG/5ML VIAL,7055340,CDM,636,RC,J2001,HCPCS,Outpatient,,,26,13,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,0.03,20.8,
TUMS (CAL CARBONATE) 500MG,7055379,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZCARRASYN HYDROGEL DRESSING TOPICAL,7055400,CDM,250,RC,,,Outpatient,,,868.5,434.25,,233.28,26.86,,,percent of total billed charges,26.86% of total billed charges,651.38,75,,,percent of total billed charges,75% of total billed charges ,651.38,75,,,percent of total billed charges,75% of total billed charges ,208.44,24,,,percent of total billed charges,24% of total billed charges ,651.38,75,,,percent of total billed charges,75% of total billed charges ,651.38,75,,,percent of total billed charges,75% of total billed charges ,694.8,80,,,percent of total billed charges,80% of total billed charges ,210.52,24.24,,,percent of total billed charges,24.24% of total billed charges ,437.72,50.4,,,percent of total billed charges,50.4% of total billed charges ,651.38,75,,,percent of total billed charges,75% of total billed charges ,212.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,233.28,26.86,,,percent of total billed charges,26.86% of total billed charges,208.44,24,,,percent of total billed charges,24% of total billed charges ,270.97,31.2,,,percent of total billed charges,31.2% of total billed charges,694.8,80,,,percent of total billed charges,80% of total billed charges,208.44,24,,,percent of total billed charges,24% of total billed charges ,208.44,24,,,percent of total billed charges,24% of total billed charges ,208.44,694.8,
NULYTELY (CHL NAHCO3 KCL PEG) 4000ML,7055441,CDM,250,RC,,,Outpatient,,,351,175.5,,94.28,26.86,,,percent of total billed charges,26.86% of total billed charges,263.25,75,,,percent of total billed charges,75% of total billed charges ,263.25,75,,,percent of total billed charges,75% of total billed charges ,84.24,24,,,percent of total billed charges,24% of total billed charges ,263.25,75,,,percent of total billed charges,75% of total billed charges ,263.25,75,,,percent of total billed charges,75% of total billed charges ,280.8,80,,,percent of total billed charges,80% of total billed charges ,85.08,24.24,,,percent of total billed charges,24.24% of total billed charges ,176.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,263.25,75,,,percent of total billed charges,75% of total billed charges ,85.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,94.28,26.86,,,percent of total billed charges,26.86% of total billed charges,84.24,24,,,percent of total billed charges,24% of total billed charges ,109.51,31.2,,,percent of total billed charges,31.2% of total billed charges,280.8,80,,,percent of total billed charges,80% of total billed charges,84.24,24,,,percent of total billed charges,24% of total billed charges ,84.24,24,,,percent of total billed charges,24% of total billed charges ,84.24,280.8,
CRITIC-AID (ZINC OXIDE/PETRO) PASTE,7055478,CDM,250,RC,,,Outpatient,,,457.5,228.75,,122.88,26.86,,,percent of total billed charges,26.86% of total billed charges,343.13,75,,,percent of total billed charges,75% of total billed charges ,343.13,75,,,percent of total billed charges,75% of total billed charges ,109.8,24,,,percent of total billed charges,24% of total billed charges ,343.13,75,,,percent of total billed charges,75% of total billed charges ,343.13,75,,,percent of total billed charges,75% of total billed charges ,366,80,,,percent of total billed charges,80% of total billed charges ,110.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,230.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,343.13,75,,,percent of total billed charges,75% of total billed charges ,112,24.48,,,percent of total billed charges,24.48% of total billed charges ,122.88,26.86,,,percent of total billed charges,26.86% of total billed charges,109.8,24,,,percent of total billed charges,24% of total billed charges ,142.74,31.2,,,percent of total billed charges,31.2% of total billed charges,366,80,,,percent of total billed charges,80% of total billed charges,109.8,24,,,percent of total billed charges,24% of total billed charges ,109.8,24,,,percent of total billed charges,24% of total billed charges ,109.8,366,
ZZZDIFLUCAN (FLUCONAZOLE) 10MG/ML SUSP,7055479,CDM,250,RC,,,Outpatient,,,177,88.5,,47.54,26.86,,,percent of total billed charges,26.86% of total billed charges,132.75,75,,,percent of total billed charges,75% of total billed charges ,132.75,75,,,percent of total billed charges,75% of total billed charges ,42.48,24,,,percent of total billed charges,24% of total billed charges ,132.75,75,,,percent of total billed charges,75% of total billed charges ,132.75,75,,,percent of total billed charges,75% of total billed charges ,141.6,80,,,percent of total billed charges,80% of total billed charges ,42.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,132.75,75,,,percent of total billed charges,75% of total billed charges ,43.33,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.54,26.86,,,percent of total billed charges,26.86% of total billed charges,42.48,24,,,percent of total billed charges,24% of total billed charges ,55.22,31.2,,,percent of total billed charges,31.2% of total billed charges,141.6,80,,,percent of total billed charges,80% of total billed charges,42.48,24,,,percent of total billed charges,24% of total billed charges ,42.48,24,,,percent of total billed charges,24% of total billed charges ,42.48,141.6,
DEPAKENE (VALPROIC ACID) 250MG/5ML LQ,7055480,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
CLARITIN D (LORATIDINE/PSE) 12HR TABLET,7055482,CDM,250,RC,,,Outpatient,,,15,7.5,,4.03,26.86,,,percent of total billed charges,26.86% of total billed charges,11.25,75,,,percent of total billed charges,75% of total billed charges ,11.25,75,,,percent of total billed charges,75% of total billed charges ,3.6,24,,,percent of total billed charges,24% of total billed charges ,11.25,75,,,percent of total billed charges,75% of total billed charges ,11.25,75,,,percent of total billed charges,75% of total billed charges ,12,80,,,percent of total billed charges,80% of total billed charges ,3.64,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.25,75,,,percent of total billed charges,75% of total billed charges ,3.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.03,26.86,,,percent of total billed charges,26.86% of total billed charges,3.6,24,,,percent of total billed charges,24% of total billed charges ,4.68,31.2,,,percent of total billed charges,31.2% of total billed charges,12,80,,,percent of total billed charges,80% of total billed charges,3.6,24,,,percent of total billed charges,24% of total billed charges ,3.6,24,,,percent of total billed charges,24% of total billed charges ,3.6,12,
PROVENTIL (ALBUTEROL) 0.5MG/ML  BOTTLE,7055484,CDM,250,RC,,,Outpatient,,,203,101.5,,54.53,26.86,,,percent of total billed charges,26.86% of total billed charges,152.25,75,,,percent of total billed charges,75% of total billed charges ,152.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24,,,percent of total billed charges,24% of total billed charges ,152.25,75,,,percent of total billed charges,75% of total billed charges ,152.25,75,,,percent of total billed charges,75% of total billed charges ,162.4,80,,,percent of total billed charges,80% of total billed charges ,49.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,102.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,152.25,75,,,percent of total billed charges,75% of total billed charges ,49.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,54.53,26.86,,,percent of total billed charges,26.86% of total billed charges,48.72,24,,,percent of total billed charges,24% of total billed charges ,63.34,31.2,,,percent of total billed charges,31.2% of total billed charges,162.4,80,,,percent of total billed charges,80% of total billed charges,48.72,24,,,percent of total billed charges,24% of total billed charges ,48.72,24,,,percent of total billed charges,24% of total billed charges ,48.72,162.4,
NS (0.9% SOD CHLORIDE) 50ML PB,7055485,CDM,636,RC,J7050,HCPCS,Outpatient,,,44.5,22.25,,0.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.6,80,,,percent of total billed charges,80% of total billed charges ,10.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,10.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.68,24,,,percent of total billed charges,24% of total billed charges ,13.88,31.2,,,percent of total billed charges,31.2% of total billed charges,35.6,80,,,percent of total billed charges,80% of total billed charges,10.68,24,,,percent of total billed charges,24% of total billed charges ,10.68,24,,,percent of total billed charges,24% of total billed charges ,0.67,35.6,
ZZZESTRACE (ESTRADIOL 0.01%) VAG CRM,7055490,CDM,250,RC,,,Outpatient,,,1409,704.5,,378.46,26.86,,,percent of total billed charges,26.86% of total billed charges,1056.75,75,,,percent of total billed charges,75% of total billed charges ,1056.75,75,,,percent of total billed charges,75% of total billed charges ,338.16,24,,,percent of total billed charges,24% of total billed charges ,1056.75,75,,,percent of total billed charges,75% of total billed charges ,1056.75,75,,,percent of total billed charges,75% of total billed charges ,1127.2,80,,,percent of total billed charges,80% of total billed charges ,341.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,710.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,1056.75,75,,,percent of total billed charges,75% of total billed charges ,344.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,378.46,26.86,,,percent of total billed charges,26.86% of total billed charges,338.16,24,,,percent of total billed charges,24% of total billed charges ,439.61,31.2,,,percent of total billed charges,31.2% of total billed charges,1127.2,80,,,percent of total billed charges,80% of total billed charges,338.16,24,,,percent of total billed charges,24% of total billed charges ,338.16,24,,,percent of total billed charges,24% of total billed charges ,338.16,1127.2,
ZZZMIACALCIN (CALCITONIN-SAL) 200UNIT SP,7055492,CDM,250,RC,,,Outpatient,,,508,254,,136.45,26.86,,,percent of total billed charges,26.86% of total billed charges,381,75,,,percent of total billed charges,75% of total billed charges ,381,75,,,percent of total billed charges,75% of total billed charges ,121.92,24,,,percent of total billed charges,24% of total billed charges ,381,75,,,percent of total billed charges,75% of total billed charges ,381,75,,,percent of total billed charges,75% of total billed charges ,406.4,80,,,percent of total billed charges,80% of total billed charges ,123.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,256.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,381,75,,,percent of total billed charges,75% of total billed charges ,124.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,136.45,26.86,,,percent of total billed charges,26.86% of total billed charges,121.92,24,,,percent of total billed charges,24% of total billed charges ,158.5,31.2,,,percent of total billed charges,31.2% of total billed charges,406.4,80,,,percent of total billed charges,80% of total billed charges,121.92,24,,,percent of total billed charges,24% of total billed charges ,121.92,24,,,percent of total billed charges,24% of total billed charges ,121.92,406.4,
VITAMIN B-12 (CYANOCOB) 500MCG TAB,7055493,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
SYNTHROID (LEVOTHYROXINE) 125MCG TB,7055494,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
ZZZTRUSOPT (DORZOLAMIDE 2%) OP SOL,7055504,CDM,250,RC,,,Outpatient,,,330.5,165.25,,88.77,26.86,,,percent of total billed charges,26.86% of total billed charges,247.88,75,,,percent of total billed charges,75% of total billed charges ,247.88,75,,,percent of total billed charges,75% of total billed charges ,79.32,24,,,percent of total billed charges,24% of total billed charges ,247.88,75,,,percent of total billed charges,75% of total billed charges ,247.88,75,,,percent of total billed charges,75% of total billed charges ,264.4,80,,,percent of total billed charges,80% of total billed charges ,80.11,24.24,,,percent of total billed charges,24.24% of total billed charges ,166.57,50.4,,,percent of total billed charges,50.4% of total billed charges ,247.88,75,,,percent of total billed charges,75% of total billed charges ,80.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,88.77,26.86,,,percent of total billed charges,26.86% of total billed charges,79.32,24,,,percent of total billed charges,24% of total billed charges ,103.12,31.2,,,percent of total billed charges,31.2% of total billed charges,264.4,80,,,percent of total billed charges,80% of total billed charges,79.32,24,,,percent of total billed charges,24% of total billed charges ,79.32,24,,,percent of total billed charges,24% of total billed charges ,79.32,264.4,
TENORMIN (ATENONOL) 25MG TAB,7055505,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
PEPCID (FAMOTIDINE) 20MG/2ML INJECT,7055506,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
AMARYL (GLIMEPIRIDE) 2MG TAB,7055511,CDM,250,RC,,,Outpatient,,,16.5,8.25,,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,13.2,80,,,percent of total billed charges,80% of total billed charges ,4,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,12.38,75,,,percent of total billed charges,75% of total billed charges ,4.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.43,26.86,,,percent of total billed charges,26.86% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,5.15,31.2,,,percent of total billed charges,31.2% of total billed charges,13.2,80,,,percent of total billed charges,80% of total billed charges,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,24,,,percent of total billed charges,24% of total billed charges ,3.96,13.2,
HYDROCORTISONE 0.5% CREAM 28.4GM,7055513,CDM,250,RC,,,Outpatient,,,35,17.5,,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,28,80,,,percent of total billed charges,80% of total billed charges ,8.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,10.92,31.2,,,percent of total billed charges,31.2% of total billed charges,28,80,,,percent of total billed charges,80% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,28,
ZZZBACTROBAN (MUPIROCIN) 2% NASAL,7055517,CDM,250,RC,,,Outpatient,,,110,55,,29.55,26.86,,,percent of total billed charges,26.86% of total billed charges,82.5,75,,,percent of total billed charges,75% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.55,26.86,,,percent of total billed charges,26.86% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,88,
ZZZAMLACTIN (ALPHA HYDROX) 12% LOTION,7055518,CDM,250,RC,,,Outpatient,,,69,34.5,,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,55.2,80,,,percent of total billed charges,80% of total billed charges ,16.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,21.53,31.2,,,percent of total billed charges,31.2% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,55.2,
ZZZCLAFORAN (CEFOTAXIME) 500MG INJ,7055522,CDM,636,RC,J0698,HCPCS,Outpatient,,,32,16,,9.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
MARCAINE (BUPIVACAINE) 0.5% INJ 10ML,7055527,CDM,250,RC,,,Outpatient,,,31,15.5,,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,24.8,80,,,percent of total billed charges,80% of total billed charges ,7.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,23.25,75,,,percent of total billed charges,75% of total billed charges ,7.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,9.67,31.2,,,percent of total billed charges,31.2% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24,,,percent of total billed charges,24% of total billed charges ,7.44,24.8,
LIDOCAINE 1% 100MG/10ML SDV VIAL,7055530,CDM,636,RC,J2001,HCPCS,Outpatient,,,21.5,10.75,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,0.03,17.2,
LIDOCAINE 1% 50MG/5ML SYRINGE,7055532,CDM,636,RC,J2001,HCPCS,Outpatient,,,64,32,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.2,80,,,percent of total billed charges,80% of total billed charges ,15.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,48,75,,,percent of total billed charges,75% of total billed charges ,15.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.36,24,,,percent of total billed charges,24% of total billed charges ,19.97,31.2,,,percent of total billed charges,31.2% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,15.36,24,,,percent of total billed charges,24% of total billed charges ,15.36,24,,,percent of total billed charges,24% of total billed charges ,0.03,51.2,
"LIDOCAINE-EPI 1% 1:100,000 INJ 30ML",7055533,CDM,250,RC,,,Outpatient,,,39,19.5,,10.48,26.86,,,percent of total billed charges,26.86% of total billed charges,29.25,75,,,percent of total billed charges,75% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,9.36,24,,,percent of total billed charges,24% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,31.2,80,,,percent of total billed charges,80% of total billed charges ,9.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,19.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,29.25,75,,,percent of total billed charges,75% of total billed charges ,9.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,10.48,26.86,,,percent of total billed charges,26.86% of total billed charges,9.36,24,,,percent of total billed charges,24% of total billed charges ,12.17,31.2,,,percent of total billed charges,31.2% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,9.36,24,,,percent of total billed charges,24% of total billed charges ,9.36,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,
LIDOCAINE 2% 100MG/5ML SYRINGE,7055535,CDM,636,RC,J2001,HCPCS,Outpatient,,,53.5,26.75,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.8,80,,,percent of total billed charges,80% of total billed charges ,12.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,26.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.13,75,,,percent of total billed charges,75% of total billed charges ,13.1,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.84,24,,,percent of total billed charges,24% of total billed charges ,16.69,31.2,,,percent of total billed charges,31.2% of total billed charges,42.8,80,,,percent of total billed charges,80% of total billed charges,12.84,24,,,percent of total billed charges,24% of total billed charges ,12.84,24,,,percent of total billed charges,24% of total billed charges ,0.03,42.8,
LIDOCAINE-EPI 2%  INJ 20ML,7055537,CDM,250,RC,,,Outpatient,,,35,17.5,,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,28,80,,,percent of total billed charges,80% of total billed charges ,8.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,10.92,31.2,,,percent of total billed charges,31.2% of total billed charges,28,80,,,percent of total billed charges,80% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,28,
LIORISAL (BACLOFEN) 10MG TAB,7055538,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
LIDOCAINE 2% 400MG/20ML VIAL,7055540,CDM,636,RC,J2001,HCPCS,Outpatient,,,23.5,11.75,,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.64,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.8,80,,,percent of total billed charges,80% of total billed charges ,5.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.64,24,,,percent of total billed charges,24% of total billed charges ,7.33,31.2,,,percent of total billed charges,31.2% of total billed charges,18.8,80,,,percent of total billed charges,80% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,0.03,18.8,
GLUCOTROL XR (GLIPIZIDE ER) 5MG TAB,7055545,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZASACOL (MESALAMINE) 400MG CAP,7055546,CDM,250,RC,,,Outpatient,,,30,15,,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,24,80,,,percent of total billed charges,80% of total billed charges ,7.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,,,percent of total billed charges,31.2% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,
METHYLENE BLUE 1% 10MG/ML AMP,7055553,CDM,636,RC,Q9968,HCPCS,Outpatient,,,1008,504,,270.75,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,241.92,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,806.4,80,,,percent of total billed charges,80% of total billed charges ,244.34,24.24,,,percent of total billed charges,24.24% of total billed charges ,508.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,756,75,,,percent of total billed charges,75% of total billed charges ,246.76,24.48,,,percent of total billed charges,24.48% of total billed charges ,270.75,26.86,,,percent of total billed charges,26.86% of total billed charges,241.92,24,,,percent of total billed charges,24% of total billed charges ,314.5,31.2,,,percent of total billed charges,31.2% of total billed charges,806.4,80,,,percent of total billed charges,80% of total billed charges,241.92,24,,,percent of total billed charges,24% of total billed charges ,241.92,24,,,percent of total billed charges,24% of total billed charges ,241.92,806.4,
ZZZEPIVIR (LAMIVUDINE) 150MG TAB,7055555,CDM,250,RC,,,Outpatient,,,45.5,22.75,,12.22,26.86,,,percent of total billed charges,26.86% of total billed charges,34.13,75,,,percent of total billed charges,75% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.22,26.86,,,percent of total billed charges,26.86% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,36.4,80,,,percent of total billed charges,80% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,36.4,
MORPHINE SULFATE 5MG/ML INJ,7055557,CDM,636,RC,J2270,HCPCS,Outpatient,,,18.5,9.25,,4.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
ETHYL CHLORIDE TOPICAL ANESTH SPRAY,7055558,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
GLUCOPHAGE (METFORMIN) 850MG TAB,7055560,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
K-PHOS NEUTRAL (PHOSPHORUS) TAB,7055563,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ZZZVEXOL (RIMEXOLONE 1%) OPTH SOLN,7055564,CDM,250,RC,,,Outpatient,,,185.5,92.75,,49.83,26.86,,,percent of total billed charges,26.86% of total billed charges,139.13,75,,,percent of total billed charges,75% of total billed charges ,139.13,75,,,percent of total billed charges,75% of total billed charges ,44.52,24,,,percent of total billed charges,24% of total billed charges ,139.13,75,,,percent of total billed charges,75% of total billed charges ,139.13,75,,,percent of total billed charges,75% of total billed charges ,148.4,80,,,percent of total billed charges,80% of total billed charges ,44.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,93.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,139.13,75,,,percent of total billed charges,75% of total billed charges ,45.41,24.48,,,percent of total billed charges,24.48% of total billed charges ,49.83,26.86,,,percent of total billed charges,26.86% of total billed charges,44.52,24,,,percent of total billed charges,24% of total billed charges ,57.88,31.2,,,percent of total billed charges,31.2% of total billed charges,148.4,80,,,percent of total billed charges,80% of total billed charges,44.52,24,,,percent of total billed charges,24% of total billed charges ,44.52,24,,,percent of total billed charges,24% of total billed charges ,44.52,148.4,
ARICEPT (DONEPEZIL) 5MG TAB,7055567,CDM,250,RC,,,Outpatient,,,16,8,,4.3,26.86,,,percent of total billed charges,26.86% of total billed charges,12,75,,,percent of total billed charges,75% of total billed charges ,12,75,,,percent of total billed charges,75% of total billed charges ,3.84,24,,,percent of total billed charges,24% of total billed charges ,12,75,,,percent of total billed charges,75% of total billed charges ,12,75,,,percent of total billed charges,75% of total billed charges ,12.8,80,,,percent of total billed charges,80% of total billed charges ,3.88,24.24,,,percent of total billed charges,24.24% of total billed charges ,8.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,12,75,,,percent of total billed charges,75% of total billed charges ,3.92,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.3,26.86,,,percent of total billed charges,26.86% of total billed charges,3.84,24,,,percent of total billed charges,24% of total billed charges ,4.99,31.2,,,percent of total billed charges,31.2% of total billed charges,12.8,80,,,percent of total billed charges,80% of total billed charges,3.84,24,,,percent of total billed charges,24% of total billed charges ,3.84,24,,,percent of total billed charges,24% of total billed charges ,3.84,12.8,
ZZZFLOVENT HFA (FLUTICASONE ) 220MCG INH,7055571,CDM,250,RC,,,Outpatient,,,1950,975,,523.77,26.86,,,percent of total billed charges,26.86% of total billed charges,1462.5,75,,,percent of total billed charges,75% of total billed charges ,1462.5,75,,,percent of total billed charges,75% of total billed charges ,468,24,,,percent of total billed charges,24% of total billed charges ,1462.5,75,,,percent of total billed charges,75% of total billed charges ,1462.5,75,,,percent of total billed charges,75% of total billed charges ,1560,80,,,percent of total billed charges,80% of total billed charges ,472.68,24.24,,,percent of total billed charges,24.24% of total billed charges ,982.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,1462.5,75,,,percent of total billed charges,75% of total billed charges ,477.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,523.77,26.86,,,percent of total billed charges,26.86% of total billed charges,468,24,,,percent of total billed charges,24% of total billed charges ,608.4,31.2,,,percent of total billed charges,31.2% of total billed charges,1560,80,,,percent of total billed charges,80% of total billed charges,468,24,,,percent of total billed charges,24% of total billed charges ,468,24,,,percent of total billed charges,24% of total billed charges ,468,1560,
NIASPAN (NIACIN ER) 500MG TAB,7055573,CDM,250,RC,,,Outpatient,,,30,15,,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,24,80,,,percent of total billed charges,80% of total billed charges ,7.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,15.12,50.4,,,percent of total billed charges,50.4% of total billed charges ,22.5,75,,,percent of total billed charges,75% of total billed charges ,7.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.06,26.86,,,percent of total billed charges,26.86% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,9.36,31.2,,,percent of total billed charges,31.2% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,,,percent of total billed charges,24% of total billed charges ,7.2,24,
ZZZCALAN SR (VERAPAMIL ER) 120MG TAB,7055574,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
QUELICIN (SUCCINYLCHOLINE) 200MG/10ML,7055576,CDM,636,RC,J0330,HCPCS,Outpatient,,,121.5,60.75,,32.63,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,97.2,80,,,percent of total billed charges,80% of total billed charges ,29.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.13,75,,,percent of total billed charges,75% of total billed charges ,29.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.63,26.86,,,percent of total billed charges,26.86% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,37.91,31.2,,,percent of total billed charges,31.2% of total billed charges,97.2,80,,,percent of total billed charges,80% of total billed charges,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,24,,,percent of total billed charges,24% of total billed charges ,29.16,97.2,
RIFAMPIN (RIFADIN) 600MG/25ML VIAL,7055581,CDM,250,RC,,,Outpatient,,,888,444,,238.52,26.86,,,percent of total billed charges,26.86% of total billed charges,666,75,,,percent of total billed charges,75% of total billed charges ,666,75,,,percent of total billed charges,75% of total billed charges ,213.12,24,,,percent of total billed charges,24% of total billed charges ,666,75,,,percent of total billed charges,75% of total billed charges ,666,75,,,percent of total billed charges,75% of total billed charges ,710.4,80,,,percent of total billed charges,80% of total billed charges ,215.25,24.24,,,percent of total billed charges,24.24% of total billed charges ,447.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,666,75,,,percent of total billed charges,75% of total billed charges ,217.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,238.52,26.86,,,percent of total billed charges,26.86% of total billed charges,213.12,24,,,percent of total billed charges,24% of total billed charges ,277.06,31.2,,,percent of total billed charges,31.2% of total billed charges,710.4,80,,,percent of total billed charges,80% of total billed charges,213.12,24,,,percent of total billed charges,24% of total billed charges ,213.12,24,,,percent of total billed charges,24% of total billed charges ,213.12,710.4,
AUGMENTIN (AMOX/CLAV) 875/125 TAB,7055582,CDM,250,RC,,,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
DURAGESIC (FENTANYL) 75MCG/HR PATCH,7055583,CDM,250,RC,,,Outpatient,,,294.5,147.25,,79.1,26.86,,,percent of total billed charges,26.86% of total billed charges,220.88,75,,,percent of total billed charges,75% of total billed charges ,220.88,75,,,percent of total billed charges,75% of total billed charges ,70.68,24,,,percent of total billed charges,24% of total billed charges ,220.88,75,,,percent of total billed charges,75% of total billed charges ,220.88,75,,,percent of total billed charges,75% of total billed charges ,235.6,80,,,percent of total billed charges,80% of total billed charges ,71.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,148.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,220.88,75,,,percent of total billed charges,75% of total billed charges ,72.09,24.48,,,percent of total billed charges,24.48% of total billed charges ,79.1,26.86,,,percent of total billed charges,26.86% of total billed charges,70.68,24,,,percent of total billed charges,24% of total billed charges ,91.88,31.2,,,percent of total billed charges,31.2% of total billed charges,235.6,80,,,percent of total billed charges,80% of total billed charges,70.68,24,,,percent of total billed charges,24% of total billed charges ,70.68,24,,,percent of total billed charges,24% of total billed charges ,70.68,235.6,
DURAGESIC (FENTANYL) 50MCG/HR PTCH,7055584,CDM,636,RC,J3010,HCPCS,Outpatient,,,198,99,,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,158.4,80,,,percent of total billed charges,80% of total billed charges ,48,24.24,,,percent of total billed charges,24.24% of total billed charges ,99.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,148.5,75,,,percent of total billed charges,75% of total billed charges ,48.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.52,24,,,percent of total billed charges,24% of total billed charges ,61.78,31.2,,,percent of total billed charges,31.2% of total billed charges,158.4,80,,,percent of total billed charges,80% of total billed charges,47.52,24,,,percent of total billed charges,24% of total billed charges ,47.52,24,,,percent of total billed charges,24% of total billed charges ,0.97,158.4,
DURAGESIC (FENTANYL) 25MCG/HR PTCH,7055585,CDM,250,RC,,,Outpatient,,,76.5,38.25,,20.55,26.86,,,percent of total billed charges,26.86% of total billed charges,57.38,75,,,percent of total billed charges,75% of total billed charges ,57.38,75,,,percent of total billed charges,75% of total billed charges ,18.36,24,,,percent of total billed charges,24% of total billed charges ,57.38,75,,,percent of total billed charges,75% of total billed charges ,57.38,75,,,percent of total billed charges,75% of total billed charges ,61.2,80,,,percent of total billed charges,80% of total billed charges ,18.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,38.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,57.38,75,,,percent of total billed charges,75% of total billed charges ,18.73,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.55,26.86,,,percent of total billed charges,26.86% of total billed charges,18.36,24,,,percent of total billed charges,24% of total billed charges ,23.87,31.2,,,percent of total billed charges,31.2% of total billed charges,61.2,80,,,percent of total billed charges,80% of total billed charges,18.36,24,,,percent of total billed charges,24% of total billed charges ,18.36,24,,,percent of total billed charges,24% of total billed charges ,18.36,61.2,
ZZZESTRATEST HS (ESTERIFIED ESTROG) TAB,7055587,CDM,250,RC,,,Outpatient,,,28,14,,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,22.4,80,,,percent of total billed charges,80% of total billed charges ,6.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,8.74,31.2,,,percent of total billed charges,31.2% of total billed charges,22.4,80,,,percent of total billed charges,80% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,22.4,
SYNTHROID (LEVOTHYROXINE)  25MCG TB,7055597,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
SUPRANE (DESFLURANE) 240ML INH LIQ,7055598,CDM,250,RC,,,Outpatient,,,620,310,,166.53,26.86,,,percent of total billed charges,26.86% of total billed charges,465,75,,,percent of total billed charges,75% of total billed charges ,465,75,,,percent of total billed charges,75% of total billed charges ,148.8,24,,,percent of total billed charges,24% of total billed charges ,465,75,,,percent of total billed charges,75% of total billed charges ,465,75,,,percent of total billed charges,75% of total billed charges ,496,80,,,percent of total billed charges,80% of total billed charges ,150.29,24.24,,,percent of total billed charges,24.24% of total billed charges ,312.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,465,75,,,percent of total billed charges,75% of total billed charges ,151.78,24.48,,,percent of total billed charges,24.48% of total billed charges ,166.53,26.86,,,percent of total billed charges,26.86% of total billed charges,148.8,24,,,percent of total billed charges,24% of total billed charges ,193.44,31.2,,,percent of total billed charges,31.2% of total billed charges,496,80,,,percent of total billed charges,80% of total billed charges,148.8,24,,,percent of total billed charges,24% of total billed charges ,148.8,24,,,percent of total billed charges,24% of total billed charges ,148.8,496,
DILANTIN (PHENYTOIN) 125MG/5ML SUSP,7055604,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
COREG (CARVEDILOL) 3.125MG TAB,7055607,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
COMBIVENT (ALBUT/IPRAT)RESPIMAT INHALER,7055608,CDM,250,RC,,,Outpatient,,,1682,841,,451.79,26.86,,,percent of total billed charges,26.86% of total billed charges,1261.5,75,,,percent of total billed charges,75% of total billed charges ,1261.5,75,,,percent of total billed charges,75% of total billed charges ,403.68,24,,,percent of total billed charges,24% of total billed charges ,1261.5,75,,,percent of total billed charges,75% of total billed charges ,1261.5,75,,,percent of total billed charges,75% of total billed charges ,1345.6,80,,,percent of total billed charges,80% of total billed charges ,407.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,847.73,50.4,,,percent of total billed charges,50.4% of total billed charges ,1261.5,75,,,percent of total billed charges,75% of total billed charges ,411.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,451.79,26.86,,,percent of total billed charges,26.86% of total billed charges,403.68,24,,,percent of total billed charges,24% of total billed charges ,524.78,31.2,,,percent of total billed charges,31.2% of total billed charges,1345.6,80,,,percent of total billed charges,80% of total billed charges,403.68,24,,,percent of total billed charges,24% of total billed charges ,403.68,24,,,percent of total billed charges,24% of total billed charges ,403.68,1345.6,
OXYCONTIN (OXYCODONE CR) 10MG TAB,7055611,CDM,250,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
"IMOVAX RABIES ( VACC, HUMAN) 2.5U/ML",7055613,CDM,636,RC,90675,HCPCS,Outpatient,,,2006.5,1003.25,,324.74,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,481.56,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1605.2,80,,,percent of total billed charges,80% of total billed charges ,486.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,1011.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,1504.88,75,,,percent of total billed charges,75% of total billed charges ,491.19,24.48,,,percent of total billed charges,24.48% of total billed charges ,324.74,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,481.56,24,,,percent of total billed charges,24% of total billed charges ,626.03,31.2,,,percent of total billed charges,31.2% of total billed charges,1605.2,80,,,percent of total billed charges,80% of total billed charges,481.56,24,,,percent of total billed charges,24% of total billed charges ,481.56,24,,,percent of total billed charges,24% of total billed charges ,324.74,1605.2,
XALATAN (LATANOPROST 0.005%) OPTH SOL,7055619,CDM,250,RC,,,Outpatient,,,465.5,232.75,,125.03,26.86,,,percent of total billed charges,26.86% of total billed charges,349.13,75,,,percent of total billed charges,75% of total billed charges ,349.13,75,,,percent of total billed charges,75% of total billed charges ,111.72,24,,,percent of total billed charges,24% of total billed charges ,349.13,75,,,percent of total billed charges,75% of total billed charges ,349.13,75,,,percent of total billed charges,75% of total billed charges ,372.4,80,,,percent of total billed charges,80% of total billed charges ,112.84,24.24,,,percent of total billed charges,24.24% of total billed charges ,234.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,349.13,75,,,percent of total billed charges,75% of total billed charges ,113.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,125.03,26.86,,,percent of total billed charges,26.86% of total billed charges,111.72,24,,,percent of total billed charges,24% of total billed charges ,145.24,31.2,,,percent of total billed charges,31.2% of total billed charges,372.4,80,,,percent of total billed charges,80% of total billed charges,111.72,24,,,percent of total billed charges,24% of total billed charges ,111.72,24,,,percent of total billed charges,24% of total billed charges ,111.72,372.4,
POTASSIUM CL 10MEQ/100ML IVPB,7055626,CDM,636,RC,J3480,HCPCS,Outpatient,,,47.5,23.75,,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,0.12,38,
ZYPREXA (OLANZAPINE) 2.5MG TAB,7055628,CDM,250,RC,,,Outpatient,,,65,32.5,,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,52,80,,,percent of total billed charges,80% of total billed charges ,15.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,32.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,48.75,75,,,percent of total billed charges,75% of total billed charges ,15.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.46,26.86,,,percent of total billed charges,26.86% of total billed charges,15.6,24,,,percent of total billed charges,24% of total billed charges ,20.28,31.2,,,percent of total billed charges,31.2% of total billed charges,52,80,,,percent of total billed charges,80% of total billed charges,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,24,,,percent of total billed charges,24% of total billed charges ,15.6,52,
ZZZROBINUL (GLYCOPYRROLATE) 1MG TAB,7055629,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
MUCOMYST (ACETYLCYSTEINE) 20% SOLU,7055631,CDM,250,RC,,,Outpatient,,,132,66,,35.46,26.86,,,percent of total billed charges,26.86% of total billed charges,99,75,,,percent of total billed charges,75% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,31.68,24,,,percent of total billed charges,24% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,105.6,80,,,percent of total billed charges,80% of total billed charges ,32,24.24,,,percent of total billed charges,24.24% of total billed charges ,66.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,99,75,,,percent of total billed charges,75% of total billed charges ,32.31,24.48,,,percent of total billed charges,24.48% of total billed charges ,35.46,26.86,,,percent of total billed charges,26.86% of total billed charges,31.68,24,,,percent of total billed charges,24% of total billed charges ,41.18,31.2,,,percent of total billed charges,31.2% of total billed charges,105.6,80,,,percent of total billed charges,80% of total billed charges,31.68,24,,,percent of total billed charges,24% of total billed charges ,31.68,24,,,percent of total billed charges,24% of total billed charges ,31.68,105.6,
ZZZOXYCONTIN (OXYCODONE CR) 40MG TAB,7055640,CDM,250,RC,,,Outpatient,,,75,37.5,,20.15,26.86,,,percent of total billed charges,26.86% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,18,24,,,percent of total billed charges,24% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,60,80,,,percent of total billed charges,80% of total billed charges ,18.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.8,50.4,,,percent of total billed charges,50.4% of total billed charges ,56.25,75,,,percent of total billed charges,75% of total billed charges ,18.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.15,26.86,,,percent of total billed charges,26.86% of total billed charges,18,24,,,percent of total billed charges,24% of total billed charges ,23.4,31.2,,,percent of total billed charges,31.2% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,18,24,,,percent of total billed charges,24% of total billed charges ,18,24,,,percent of total billed charges,24% of total billed charges ,18,60,
DEPAKOTE (DIVALPROEX DR) 500MG TAB,7055644,CDM,250,RC,,,Outpatient,,,15,7.5,,4.03,26.86,,,percent of total billed charges,26.86% of total billed charges,11.25,75,,,percent of total billed charges,75% of total billed charges ,11.25,75,,,percent of total billed charges,75% of total billed charges ,3.6,24,,,percent of total billed charges,24% of total billed charges ,11.25,75,,,percent of total billed charges,75% of total billed charges ,11.25,75,,,percent of total billed charges,75% of total billed charges ,12,80,,,percent of total billed charges,80% of total billed charges ,3.64,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.25,75,,,percent of total billed charges,75% of total billed charges ,3.67,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.03,26.86,,,percent of total billed charges,26.86% of total billed charges,3.6,24,,,percent of total billed charges,24% of total billed charges ,4.68,31.2,,,percent of total billed charges,31.2% of total billed charges,12,80,,,percent of total billed charges,80% of total billed charges,3.6,24,,,percent of total billed charges,24% of total billed charges ,3.6,24,,,percent of total billed charges,24% of total billed charges ,3.6,12,
ZZZTIMOPTIC GEL (TIMOLOL) 0.5% OP SOL,7055647,CDM,250,RC,,,Outpatient,,,804.5,402.25,,216.09,26.86,,,percent of total billed charges,26.86% of total billed charges,603.38,75,,,percent of total billed charges,75% of total billed charges ,603.38,75,,,percent of total billed charges,75% of total billed charges ,193.08,24,,,percent of total billed charges,24% of total billed charges ,603.38,75,,,percent of total billed charges,75% of total billed charges ,603.38,75,,,percent of total billed charges,75% of total billed charges ,643.6,80,,,percent of total billed charges,80% of total billed charges ,195.01,24.24,,,percent of total billed charges,24.24% of total billed charges ,405.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,603.38,75,,,percent of total billed charges,75% of total billed charges ,196.94,24.48,,,percent of total billed charges,24.48% of total billed charges ,216.09,26.86,,,percent of total billed charges,26.86% of total billed charges,193.08,24,,,percent of total billed charges,24% of total billed charges ,251,31.2,,,percent of total billed charges,31.2% of total billed charges,643.6,80,,,percent of total billed charges,80% of total billed charges,193.08,24,,,percent of total billed charges,24% of total billed charges ,193.08,24,,,percent of total billed charges,24% of total billed charges ,193.08,643.6,
ZZZTEGRETOL (CARBAMAZEPINE) 100MG/5ML SY,7055648,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
VALTREX (VALACYCLOVIR) 500MG TAB,7055649,CDM,250,RC,,,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
MINERAL OIL ENEMA 133ML,7055653,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ZZZCRIXIVAN (INDINAVIR) 400MG CAP,7055655,CDM,250,RC,,,Outpatient,,,24.5,12.25,,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,19.6,80,,,percent of total billed charges,80% of total billed charges ,5.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,12.35,50.4,,,percent of total billed charges,50.4% of total billed charges ,18.38,75,,,percent of total billed charges,75% of total billed charges ,6,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.58,26.86,,,percent of total billed charges,26.86% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,7.64,31.2,,,percent of total billed charges,31.2% of total billed charges,19.6,80,,,percent of total billed charges,80% of total billed charges,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,24,,,percent of total billed charges,24% of total billed charges ,5.88,19.6,
PLAVIX (CLOPIDOGREL) 75MG TAB,7055660,CDM,250,RC,,,Outpatient,,,43.5,21.75,,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,34.8,80,,,percent of total billed charges,80% of total billed charges ,10.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.92,50.4,,,percent of total billed charges,50.4% of total billed charges ,32.63,75,,,percent of total billed charges,75% of total billed charges ,10.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.68,26.86,,,percent of total billed charges,26.86% of total billed charges,10.44,24,,,percent of total billed charges,24% of total billed charges ,13.57,31.2,,,percent of total billed charges,31.2% of total billed charges,34.8,80,,,percent of total billed charges,80% of total billed charges,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,24,,,percent of total billed charges,24% of total billed charges ,10.44,34.8,
ZYPREXA (OLANZAPINE) 10MG TAB,7055663,CDM,250,RC,,,Outpatient,,,71,35.5,,19.07,26.86,,,percent of total billed charges,26.86% of total billed charges,53.25,75,,,percent of total billed charges,75% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,56.8,80,,,percent of total billed charges,80% of total billed charges ,17.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,53.25,75,,,percent of total billed charges,75% of total billed charges ,17.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.07,26.86,,,percent of total billed charges,26.86% of total billed charges,17.04,24,,,percent of total billed charges,24% of total billed charges ,22.15,31.2,,,percent of total billed charges,31.2% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,17.04,24,,,percent of total billed charges,24% of total billed charges ,17.04,24,,,percent of total billed charges,24% of total billed charges ,17.04,56.8,
TOBREX (TOBRAMYCIN 0.3%) O. O. 3.5G,7055665,CDM,250,RC,,,Outpatient,,,1001,500.5,,268.87,26.86,,,percent of total billed charges,26.86% of total billed charges,750.75,75,,,percent of total billed charges,75% of total billed charges ,750.75,75,,,percent of total billed charges,75% of total billed charges ,240.24,24,,,percent of total billed charges,24% of total billed charges ,750.75,75,,,percent of total billed charges,75% of total billed charges ,750.75,75,,,percent of total billed charges,75% of total billed charges ,800.8,80,,,percent of total billed charges,80% of total billed charges ,242.64,24.24,,,percent of total billed charges,24.24% of total billed charges ,504.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,750.75,75,,,percent of total billed charges,75% of total billed charges ,245.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,268.87,26.86,,,percent of total billed charges,26.86% of total billed charges,240.24,24,,,percent of total billed charges,24% of total billed charges ,312.31,31.2,,,percent of total billed charges,31.2% of total billed charges,800.8,80,,,percent of total billed charges,80% of total billed charges,240.24,24,,,percent of total billed charges,24% of total billed charges ,240.24,24,,,percent of total billed charges,24% of total billed charges ,240.24,800.8,
SENNA PLUS (SENNA/DOCUSATE) TAB,7055666,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZEVISTA (ESTROGEN) 60MG TAB,7055671,CDM,250,RC,,,Outpatient,,,45.5,22.75,,12.22,26.86,,,percent of total billed charges,26.86% of total billed charges,34.13,75,,,percent of total billed charges,75% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,36.4,80,,,percent of total billed charges,80% of total billed charges ,11.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.93,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.13,75,,,percent of total billed charges,75% of total billed charges ,11.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.22,26.86,,,percent of total billed charges,26.86% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,14.2,31.2,,,percent of total billed charges,31.2% of total billed charges,36.4,80,,,percent of total billed charges,80% of total billed charges,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,24,,,percent of total billed charges,24% of total billed charges ,10.92,36.4,
REMERON (MIRTAZAPINE) 15MG TAB,7055672,CDM,250,RC,,,Outpatient,,,22.5,11.25,,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,18,
ZZZAVAPRO (IRBESARTAN) 75MG TAB,7055673,CDM,250,RC,,,Outpatient,,,23.5,11.75,,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,18.8,80,,,percent of total billed charges,80% of total billed charges ,5.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,17.63,75,,,percent of total billed charges,75% of total billed charges ,5.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.31,26.86,,,percent of total billed charges,26.86% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,7.33,31.2,,,percent of total billed charges,31.2% of total billed charges,18.8,80,,,percent of total billed charges,80% of total billed charges,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,24,,,percent of total billed charges,24% of total billed charges ,5.64,18.8,
WELLBUTRIN XL (BUPROPION) 150MG TB (QD),7055674,CDM,250,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
CORDARONE (AMIODARONE) 50MG/ML INJ,7055677,CDM,636,RC,J0282,HCPCS,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
LABETALOL 200MG TAB,7055679,CDM,250,RC,,,Outpatient,,,28,14,,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,22.4,80,,,percent of total billed charges,80% of total billed charges ,6.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,14.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,21,75,,,percent of total billed charges,75% of total billed charges ,6.85,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.52,26.86,,,percent of total billed charges,26.86% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,8.74,31.2,,,percent of total billed charges,31.2% of total billed charges,22.4,80,,,percent of total billed charges,80% of total billed charges,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,24,,,percent of total billed charges,24% of total billed charges ,6.72,22.4,
LEVAQUIN (LEVOFLOXACIN) 500MG/100ML PREM,7055681,CDM,636,RC,J1956,HCPCS,Outpatient,,,78.5,39.25,,21.09,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.8,80,,,percent of total billed charges,80% of total billed charges ,19.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.88,75,,,percent of total billed charges,75% of total billed charges ,19.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.09,26.86,,,percent of total billed charges,26.86% of total billed charges,18.84,24,,,percent of total billed charges,24% of total billed charges ,24.49,31.2,,,percent of total billed charges,31.2% of total billed charges,62.8,80,,,percent of total billed charges,80% of total billed charges,18.84,24,,,percent of total billed charges,24% of total billed charges ,18.84,24,,,percent of total billed charges,24% of total billed charges ,18.84,62.8,
MARCAINE W/EPI (BUP/EPI) 0.25% 30ML,7055687,CDM,250,RC,,,Outpatient,,,57.5,28.75,,15.44,26.86,,,percent of total billed charges,26.86% of total billed charges,43.13,75,,,percent of total billed charges,75% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,13.8,24,,,percent of total billed charges,24% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,46,80,,,percent of total billed charges,80% of total billed charges ,13.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,28.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,43.13,75,,,percent of total billed charges,75% of total billed charges ,14.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.44,26.86,,,percent of total billed charges,26.86% of total billed charges,13.8,24,,,percent of total billed charges,24% of total billed charges ,17.94,31.2,,,percent of total billed charges,31.2% of total billed charges,46,80,,,percent of total billed charges,80% of total billed charges,13.8,24,,,percent of total billed charges,24% of total billed charges ,13.8,24,,,percent of total billed charges,24% of total billed charges ,13.8,46,
INSULIN-RAPID (HUMALOG) VIAL 10ML,7055689,CDM,636,RC,J1817,HCPCS,Outpatient,,,1,0.5,,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.24,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.8,80,,,percent of total billed charges,80% of total billed charges ,0.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,0.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.31,31.2,,,percent of total billed charges,31.2% of total billed charges,0.8,80,,,percent of total billed charges,80% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,0.8,
CELEXA (CITALOPRAM) 20MG TAB,7055693,CDM,250,RC,,,Outpatient,,,26,13,,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,20.8,80,,,percent of total billed charges,80% of total billed charges ,6.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,19.5,75,,,percent of total billed charges,75% of total billed charges ,6.36,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.98,26.86,,,percent of total billed charges,26.86% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,8.11,31.2,,,percent of total billed charges,31.2% of total billed charges,20.8,80,,,percent of total billed charges,80% of total billed charges,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,24,,,percent of total billed charges,24% of total billed charges ,6.24,20.8,
DEMADEX (TORSEMIDE) 20MG TAB,7055695,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
TOBRAMYCIN 0.3% OPTH SOLN 5ML,7055700,CDM,250,RC,,,Outpatient,,,81.5,40.75,,21.89,26.86,,,percent of total billed charges,26.86% of total billed charges,61.13,75,,,percent of total billed charges,75% of total billed charges ,61.13,75,,,percent of total billed charges,75% of total billed charges ,19.56,24,,,percent of total billed charges,24% of total billed charges ,61.13,75,,,percent of total billed charges,75% of total billed charges ,61.13,75,,,percent of total billed charges,75% of total billed charges ,65.2,80,,,percent of total billed charges,80% of total billed charges ,19.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.08,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.13,75,,,percent of total billed charges,75% of total billed charges ,19.95,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.89,26.86,,,percent of total billed charges,26.86% of total billed charges,19.56,24,,,percent of total billed charges,24% of total billed charges ,25.43,31.2,,,percent of total billed charges,31.2% of total billed charges,65.2,80,,,percent of total billed charges,80% of total billed charges,19.56,24,,,percent of total billed charges,24% of total billed charges ,19.56,24,,,percent of total billed charges,24% of total billed charges ,19.56,65.2,
APRESOLINE (HYDRALAZINE) 20MG/ML INJ,7055710,CDM,636,RC,J0360,HCPCS,Outpatient,,,95,47.5,,5.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,5.59,76,
NS+KCL 40MEQ 1000ML IV,7055712,CDM,636,RC,J3480,HCPCS,Outpatient,,,73,36.5,,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,0.12,58.4,
NS+KCL 20MEQ 1000ML IV,7055713,CDM,636,RC,J3480,HCPCS,Outpatient,,,66,33,,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.8,80,,,percent of total billed charges,80% of total billed charges ,16,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,16.16,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.84,24,,,percent of total billed charges,24% of total billed charges ,20.59,31.2,,,percent of total billed charges,31.2% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,0.12,52.8,
D5 LR KCL 20MEQ 1000ML IV,7055714,CDM,636,RC,J3480,HCPCS,Outpatient,,,68,34,,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.32,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.4,80,,,percent of total billed charges,80% of total billed charges ,16.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.27,50.4,,,percent of total billed charges,50.4% of total billed charges ,51,75,,,percent of total billed charges,75% of total billed charges ,16.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.32,24,,,percent of total billed charges,24% of total billed charges ,21.22,31.2,,,percent of total billed charges,31.2% of total billed charges,54.4,80,,,percent of total billed charges,80% of total billed charges,16.32,24,,,percent of total billed charges,24% of total billed charges ,16.32,24,,,percent of total billed charges,24% of total billed charges ,0.12,54.4,
ZOFRAN ODT (ONDANSETRON) 4MG TAB,7055718,CDM,636,RC,Q0162,HCPCS,Outpatient,,,122,61,,32.77,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.28,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,97.6,80,,,percent of total billed charges,80% of total billed charges ,29.57,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.5,75,,,percent of total billed charges,75% of total billed charges ,29.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.77,26.86,,,percent of total billed charges,26.86% of total billed charges,29.28,24,,,percent of total billed charges,24% of total billed charges ,38.06,31.2,,,percent of total billed charges,31.2% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,29.28,24,,,percent of total billed charges,24% of total billed charges ,29.28,24,,,percent of total billed charges,24% of total billed charges ,29.28,97.6,
CELEBREX (CELECOXIB) 100MG CAP,7055723,CDM,250,RC,,,Outpatient,,,36,18,,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,28.8,80,,,percent of total billed charges,80% of total billed charges ,8.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,11.23,31.2,,,percent of total billed charges,31.2% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,28.8,
DIOVAN (VALSARTAN) 80MG TAB,7055726,CDM,250,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
FLOMAX (TAMSULOSIN HCL) 0.4MG CAP,7055727,CDM,250,RC,,,Outpatient,,,33,16.5,,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,26.4,80,,,percent of total billed charges,80% of total billed charges ,8,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.63,50.4,,,percent of total billed charges,50.4% of total billed charges ,24.75,75,,,percent of total billed charges,75% of total billed charges ,8.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.86,26.86,,,percent of total billed charges,26.86% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,10.3,31.2,,,percent of total billed charges,31.2% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,24,,,percent of total billed charges,24% of total billed charges ,7.92,26.4,
TWOCAL HN 240ML CAN,7055729,CDM,250,RC,,,Outpatient,,,22.5,11.25,,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,18,80,,,percent of total billed charges,80% of total billed charges ,5.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,11.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.88,75,,,percent of total billed charges,75% of total billed charges ,5.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,6.04,26.86,,,percent of total billed charges,26.86% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,7.02,31.2,,,percent of total billed charges,31.2% of total billed charges,18,80,,,percent of total billed charges,80% of total billed charges,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,24,,,percent of total billed charges,24% of total billed charges ,5.4,18,
DILAUDID (HYDROMORPHONE) 2MG/ML INJ,7055730,CDM,636,RC,J1170,HCPCS,Outpatient,,,21.5,10.75,,4.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,4.59,17.2,
EFFEXOR XR (VENLAFAXINE ER) 37.5MG CP,7055733,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
GLUCERNA SHAKE 240ML CAN,7055734,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ZZZINTEGRELIN (EPTIFIBATIDE) 75MG/100ML,7055745,CDM,636,RC,J1327,HCPCS,Outpatient,,,2632.5,1316.25,,707.09,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,631.8,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2106,80,,,percent of total billed charges,80% of total billed charges ,638.12,24.24,,,percent of total billed charges,24.24% of total billed charges ,1326.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,1974.38,75,,,percent of total billed charges,75% of total billed charges ,644.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,707.09,26.86,,,percent of total billed charges,26.86% of total billed charges,631.8,24,,,percent of total billed charges,24% of total billed charges ,821.34,31.2,,,percent of total billed charges,31.2% of total billed charges,2106,80,,,percent of total billed charges,80% of total billed charges,631.8,24,,,percent of total billed charges,24% of total billed charges ,631.8,24,,,percent of total billed charges,24% of total billed charges ,631.8,2106,
ULTANE (SEVOFLURANE) INH LIQ,7055748,CDM,250,RC,,,Outpatient,,,127.5,63.75,,34.25,26.86,,,percent of total billed charges,26.86% of total billed charges,95.63,75,,,percent of total billed charges,75% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,30.6,24,,,percent of total billed charges,24% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,102,80,,,percent of total billed charges,80% of total billed charges ,30.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,64.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,95.63,75,,,percent of total billed charges,75% of total billed charges ,31.21,24.48,,,percent of total billed charges,24.48% of total billed charges ,34.25,26.86,,,percent of total billed charges,26.86% of total billed charges,30.6,24,,,percent of total billed charges,24% of total billed charges ,39.78,31.2,,,percent of total billed charges,31.2% of total billed charges,102,80,,,percent of total billed charges,80% of total billed charges,30.6,24,,,percent of total billed charges,24% of total billed charges ,30.6,24,,,percent of total billed charges,24% of total billed charges ,30.6,102,
LEVOBID (HYOSCYAMINE) 0.375MG TAB,7055749,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
ACTOS (PIOGLITAZONE) 15MG TAB,7055750,CDM,250,RC,,,Outpatient,,,44.5,22.25,,11.95,26.86,,,percent of total billed charges,26.86% of total billed charges,33.38,75,,,percent of total billed charges,75% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,10.68,24,,,percent of total billed charges,24% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,35.6,80,,,percent of total billed charges,80% of total billed charges ,10.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,10.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.95,26.86,,,percent of total billed charges,26.86% of total billed charges,10.68,24,,,percent of total billed charges,24% of total billed charges ,13.88,31.2,,,percent of total billed charges,31.2% of total billed charges,35.6,80,,,percent of total billed charges,80% of total billed charges,10.68,24,,,percent of total billed charges,24% of total billed charges ,10.68,24,,,percent of total billed charges,24% of total billed charges ,10.68,35.6,
TAMIFLU (OSELTAMIVIR) 75MG CAP,7055759,CDM,250,RC,,,Outpatient,,,99,49.5,,26.59,26.86,,,percent of total billed charges,26.86% of total billed charges,74.25,75,,,percent of total billed charges,75% of total billed charges ,74.25,75,,,percent of total billed charges,75% of total billed charges ,23.76,24,,,percent of total billed charges,24% of total billed charges ,74.25,75,,,percent of total billed charges,75% of total billed charges ,74.25,75,,,percent of total billed charges,75% of total billed charges ,79.2,80,,,percent of total billed charges,80% of total billed charges ,24,24.24,,,percent of total billed charges,24.24% of total billed charges ,49.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,74.25,75,,,percent of total billed charges,75% of total billed charges ,24.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.59,26.86,,,percent of total billed charges,26.86% of total billed charges,23.76,24,,,percent of total billed charges,24% of total billed charges ,30.89,31.2,,,percent of total billed charges,31.2% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,23.76,24,,,percent of total billed charges,24% of total billed charges ,23.76,24,,,percent of total billed charges,24% of total billed charges ,23.76,79.2,
IMITREX (SUMATRIPTAN) 25MG TAB,7055763,CDM,250,RC,,,Outpatient,,,141,70.5,,37.87,26.86,,,percent of total billed charges,26.86% of total billed charges,105.75,75,,,percent of total billed charges,75% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,112.8,80,,,percent of total billed charges,80% of total billed charges ,34.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,71.06,50.4,,,percent of total billed charges,50.4% of total billed charges ,105.75,75,,,percent of total billed charges,75% of total billed charges ,34.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,37.87,26.86,,,percent of total billed charges,26.86% of total billed charges,33.84,24,,,percent of total billed charges,24% of total billed charges ,43.99,31.2,,,percent of total billed charges,31.2% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,33.84,24,,,percent of total billed charges,24% of total billed charges ,33.84,24,,,percent of total billed charges,24% of total billed charges ,33.84,112.8,
LEVAQUIN (LEVOFLOXACIN) 250MG/50ML PREMI,7055771,CDM,636,RC,J1956,HCPCS,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,37.2,80,,,percent of total billed charges,80% of total billed charges ,11.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,11.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,14.51,31.2,,,percent of total billed charges,31.2% of total billed charges,37.2,80,,,percent of total billed charges,80% of total billed charges,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,24,,,percent of total billed charges,24% of total billed charges ,11.16,37.2,
POLYSPORIN (BACITRACIN/POLYM) OINT,7055773,CDM,250,RC,,,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,8.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,9.06,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,11.54,31.2,,,percent of total billed charges,31.2% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,24,,,percent of total billed charges,24% of total billed charges ,8.88,29.6,
ZZZZEBETA (BISOPROLOL FUM) 5MG TAB,7055778,CDM,250,RC,,,Outpatient,,,18.5,9.25,,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,14.8,80,,,percent of total billed charges,80% of total billed charges ,4.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.32,50.4,,,percent of total billed charges,50.4% of total billed charges ,13.88,75,,,percent of total billed charges,75% of total billed charges ,4.53,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.97,26.86,,,percent of total billed charges,26.86% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,5.77,31.2,,,percent of total billed charges,31.2% of total billed charges,14.8,80,,,percent of total billed charges,80% of total billed charges,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,24,,,percent of total billed charges,24% of total billed charges ,4.44,14.8,
ZZZHUMULIN 70/30100UNIT/ML PEN,7055781,CDM,250,RC,,,Outpatient,,,544,272,,146.12,26.86,,,percent of total billed charges,26.86% of total billed charges,408,75,,,percent of total billed charges,75% of total billed charges ,408,75,,,percent of total billed charges,75% of total billed charges ,130.56,24,,,percent of total billed charges,24% of total billed charges ,408,75,,,percent of total billed charges,75% of total billed charges ,408,75,,,percent of total billed charges,75% of total billed charges ,435.2,80,,,percent of total billed charges,80% of total billed charges ,131.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,274.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,408,75,,,percent of total billed charges,75% of total billed charges ,133.17,24.48,,,percent of total billed charges,24.48% of total billed charges ,146.12,26.86,,,percent of total billed charges,26.86% of total billed charges,130.56,24,,,percent of total billed charges,24% of total billed charges ,169.73,31.2,,,percent of total billed charges,31.2% of total billed charges,435.2,80,,,percent of total billed charges,80% of total billed charges,130.56,24,,,percent of total billed charges,24% of total billed charges ,130.56,24,,,percent of total billed charges,24% of total billed charges ,130.56,435.2,
ACTOS (PIOGLITAZONE) 45MG TAB,7055783,CDM,250,RC,,,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
BACITRACIN 500 UNIT OPTH OINTMENT,7055784,CDM,250,RC,,,Outpatient,,,484,242,,130,26.86,,,percent of total billed charges,26.86% of total billed charges,363,75,,,percent of total billed charges,75% of total billed charges ,363,75,,,percent of total billed charges,75% of total billed charges ,116.16,24,,,percent of total billed charges,24% of total billed charges ,363,75,,,percent of total billed charges,75% of total billed charges ,363,75,,,percent of total billed charges,75% of total billed charges ,387.2,80,,,percent of total billed charges,80% of total billed charges ,117.32,24.24,,,percent of total billed charges,24.24% of total billed charges ,243.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,363,75,,,percent of total billed charges,75% of total billed charges ,118.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,130,26.86,,,percent of total billed charges,26.86% of total billed charges,116.16,24,,,percent of total billed charges,24% of total billed charges ,151.01,31.2,,,percent of total billed charges,31.2% of total billed charges,387.2,80,,,percent of total billed charges,80% of total billed charges,116.16,24,,,percent of total billed charges,24% of total billed charges ,116.16,24,,,percent of total billed charges,24% of total billed charges ,116.16,387.2,
BRIMONIDINE TART 0.2% OPTH SOL,7055785,CDM,250,RC,,,Outpatient,,,168,84,,45.12,26.86,,,percent of total billed charges,26.86% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges ,126,75,,,percent of total billed charges,75% of total billed charges ,40.32,24,,,percent of total billed charges,24% of total billed charges ,126,75,,,percent of total billed charges,75% of total billed charges ,126,75,,,percent of total billed charges,75% of total billed charges ,134.4,80,,,percent of total billed charges,80% of total billed charges ,40.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,84.67,50.4,,,percent of total billed charges,50.4% of total billed charges ,126,75,,,percent of total billed charges,75% of total billed charges ,41.13,24.48,,,percent of total billed charges,24.48% of total billed charges ,45.12,26.86,,,percent of total billed charges,26.86% of total billed charges,40.32,24,,,percent of total billed charges,24% of total billed charges ,52.42,31.2,,,percent of total billed charges,31.2% of total billed charges,134.4,80,,,percent of total billed charges,80% of total billed charges,40.32,24,,,percent of total billed charges,24% of total billed charges ,40.32,24,,,percent of total billed charges,24% of total billed charges ,40.32,134.4,
ZZZDITROPAN XL (OXYBUTYNIN ER) 5MG TAB,7055786,CDM,250,RC,,,Outpatient,,,27,13.5,,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,21.6,80,,,percent of total billed charges,80% of total billed charges ,6.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,13.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,20.25,75,,,percent of total billed charges,75% of total billed charges ,6.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,7.25,26.86,,,percent of total billed charges,26.86% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,8.42,31.2,,,percent of total billed charges,31.2% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,24,,,percent of total billed charges,24% of total billed charges ,6.48,21.6,
SEROQUEL (QUETIAPINE) 100MG TAB,7055800,CDM,250,RC,,,Outpatient,,,41,20.5,,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,32.8,80,,,percent of total billed charges,80% of total billed charges ,9.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,10.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,12.79,31.2,,,percent of total billed charges,31.2% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,32.8,
FERRLECIT (SOD FERR GLUC) 62.5MG/5ML,7055804,CDM,636,RC,J2916,HCPCS,Outpatient,,,193.5,96.75,,2.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.44,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,154.8,80,,,percent of total billed charges,80% of total billed charges ,46.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,97.52,50.4,,,percent of total billed charges,50.4% of total billed charges ,145.13,75,,,percent of total billed charges,75% of total billed charges ,47.37,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,46.44,24,,,percent of total billed charges,24% of total billed charges ,60.37,31.2,,,percent of total billed charges,31.2% of total billed charges,154.8,80,,,percent of total billed charges,80% of total billed charges,46.44,24,,,percent of total billed charges,24% of total billed charges ,46.44,24,,,percent of total billed charges,24% of total billed charges ,2.37,154.8,
COREG (CARVEDILOL) 12.5MG TAB,7055810,CDM,250,RC,,,Outpatient,,,20.5,10.25,,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,16.4,80,,,percent of total billed charges,80% of total billed charges ,4.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,15.38,75,,,percent of total billed charges,75% of total billed charges ,5.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.51,26.86,,,percent of total billed charges,26.86% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,6.4,31.2,,,percent of total billed charges,31.2% of total billed charges,16.4,80,,,percent of total billed charges,80% of total billed charges,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,24,,,percent of total billed charges,24% of total billed charges ,4.92,16.4,
ZZZAGGRENOX (ASA/DIPYR) 25/200 CAP,7055813,CDM,250,RC,,,Outpatient,,,48.5,24.25,,13.03,26.86,,,percent of total billed charges,26.86% of total billed charges,36.38,75,,,percent of total billed charges,75% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,38.8,80,,,percent of total billed charges,80% of total billed charges ,11.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.38,75,,,percent of total billed charges,75% of total billed charges ,11.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.03,26.86,,,percent of total billed charges,26.86% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,15.13,31.2,,,percent of total billed charges,31.2% of total billed charges,38.8,80,,,percent of total billed charges,80% of total billed charges,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,24,,,percent of total billed charges,24% of total billed charges ,11.64,38.8,
DAKINS (SOD HYPOCHLORITE) 0.25% SOL,7055814,CDM,250,RC,,,Outpatient,,,92.5,46.25,,24.85,26.86,,,percent of total billed charges,26.86% of total billed charges,69.38,75,,,percent of total billed charges,75% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,22.2,24,,,percent of total billed charges,24% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,74,80,,,percent of total billed charges,80% of total billed charges ,22.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,46.62,50.4,,,percent of total billed charges,50.4% of total billed charges ,69.38,75,,,percent of total billed charges,75% of total billed charges ,22.64,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.85,26.86,,,percent of total billed charges,26.86% of total billed charges,22.2,24,,,percent of total billed charges,24% of total billed charges ,28.86,31.2,,,percent of total billed charges,31.2% of total billed charges,74,80,,,percent of total billed charges,80% of total billed charges,22.2,24,,,percent of total billed charges,24% of total billed charges ,22.2,24,,,percent of total billed charges,24% of total billed charges ,22.2,74,
"PROCRIT (EPOETIN) 20,000 UNIT/ML VL",7055817,CDM,636,RC,J0885,HCPCS,Outpatient,,,2587.5,1293.75,,8.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,621,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2070,80,,,percent of total billed charges,80% of total billed charges ,627.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,1304.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,1940.63,75,,,percent of total billed charges,75% of total billed charges ,633.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,621,24,,,percent of total billed charges,24% of total billed charges ,807.3,31.2,,,percent of total billed charges,31.2% of total billed charges,2070,80,,,percent of total billed charges,80% of total billed charges,621,24,,,percent of total billed charges,24% of total billed charges ,621,24,,,percent of total billed charges,24% of total billed charges ,8.89,2070,
CASODEX (BICALUTAMIDE) 50MG TAB,7055819,CDM,250,RC,,,Outpatient,,,100,50,,26.86,26.86,,,percent of total billed charges,26.86% of total billed charges,75,75,,,percent of total billed charges,75% of total billed charges ,75,75,,,percent of total billed charges,75% of total billed charges ,24,24,,,percent of total billed charges,24% of total billed charges ,75,75,,,percent of total billed charges,75% of total billed charges ,75,75,,,percent of total billed charges,75% of total billed charges ,80,80,,,percent of total billed charges,80% of total billed charges ,24.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,50.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,75,75,,,percent of total billed charges,75% of total billed charges ,24.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.86,26.86,,,percent of total billed charges,26.86% of total billed charges,24,24,,,percent of total billed charges,24% of total billed charges ,31.2,31.2,,,percent of total billed charges,31.2% of total billed charges,80,80,,,percent of total billed charges,80% of total billed charges,24,24,,,percent of total billed charges,24% of total billed charges ,24,24,,,percent of total billed charges,24% of total billed charges ,24,80,
TNKASE (TENECTEPLASE 50MG) KIT,7055823,CDM,636,RC,J3101,HCPCS,Outpatient,,,33235.91,16617.96,,8927.17,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7976.62,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26588.73,80,,,percent of total billed charges,80% of total billed charges ,8056.38,24.24,,,percent of total billed charges,24.24% of total billed charges ,16750.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,24926.93,75,,,percent of total billed charges,75% of total billed charges ,8136.15,24.48,,,percent of total billed charges,24.48% of total billed charges ,8927.17,26.86,,,percent of total billed charges,26.86% of total billed charges,7976.62,24,,,percent of total billed charges,24% of total billed charges ,10369.6,31.2,,,percent of total billed charges,31.2% of total billed charges,26588.73,80,,,percent of total billed charges,80% of total billed charges,7976.62,24,,,percent of total billed charges,24% of total billed charges ,7976.62,24,,,percent of total billed charges,24% of total billed charges ,7976.62,26588.73,
ZZZINTEGRELIN (EPTIFIBATIDE) 20MG/10ML,7055826,CDM,636,RC,J1327,HCPCS,Outpatient,,,866,433,,232.61,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,207.84,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,692.8,80,,,percent of total billed charges,80% of total billed charges ,209.92,24.24,,,percent of total billed charges,24.24% of total billed charges ,436.46,50.4,,,percent of total billed charges,50.4% of total billed charges ,649.5,75,,,percent of total billed charges,75% of total billed charges ,212,24.48,,,percent of total billed charges,24.48% of total billed charges ,232.61,26.86,,,percent of total billed charges,26.86% of total billed charges,207.84,24,,,percent of total billed charges,24% of total billed charges ,270.19,31.2,,,percent of total billed charges,31.2% of total billed charges,692.8,80,,,percent of total billed charges,80% of total billed charges,207.84,24,,,percent of total billed charges,24% of total billed charges ,207.84,24,,,percent of total billed charges,24% of total billed charges ,207.84,692.8,
GLUCOTROL XR (GLIPIZIDE ER) 2.5MG TAB,7055830,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
SODIUM PHOSPHATE 3MM/ML VIAL,7055834,CDM,250,RC,,,Outpatient,,,96,48,,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,76.8,
AZOPT (BRINZOLAMIDE) 1% OPTH DROP,7055835,CDM,250,RC,,,Outpatient,,,1277,638.5,,343,26.86,,,percent of total billed charges,26.86% of total billed charges,957.75,75,,,percent of total billed charges,75% of total billed charges ,957.75,75,,,percent of total billed charges,75% of total billed charges ,306.48,24,,,percent of total billed charges,24% of total billed charges ,957.75,75,,,percent of total billed charges,75% of total billed charges ,957.75,75,,,percent of total billed charges,75% of total billed charges ,1021.6,80,,,percent of total billed charges,80% of total billed charges ,309.54,24.24,,,percent of total billed charges,24.24% of total billed charges ,643.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,957.75,75,,,percent of total billed charges,75% of total billed charges ,312.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,343,26.86,,,percent of total billed charges,26.86% of total billed charges,306.48,24,,,percent of total billed charges,24% of total billed charges ,398.42,31.2,,,percent of total billed charges,31.2% of total billed charges,1021.6,80,,,percent of total billed charges,80% of total billed charges,306.48,24,,,percent of total billed charges,24% of total billed charges ,306.48,24,,,percent of total billed charges,24% of total billed charges ,306.48,1021.6,
MIRAPEX (PRAMIPEXOLE) 0.25MG,7055837,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
XOPENEX (LEVALBUTEROL) 0.63MG/3ML,7055838,CDM,636,RC,J7614,HCPCS,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ZZZADVAIR (FLUT/SALM) 100/50 DISKUS,7055843,CDM,250,RC,,,Outpatient,,,700.5,350.25,,188.15,26.86,,,percent of total billed charges,26.86% of total billed charges,525.38,75,,,percent of total billed charges,75% of total billed charges ,525.38,75,,,percent of total billed charges,75% of total billed charges ,168.12,24,,,percent of total billed charges,24% of total billed charges ,525.38,75,,,percent of total billed charges,75% of total billed charges ,525.38,75,,,percent of total billed charges,75% of total billed charges ,560.4,80,,,percent of total billed charges,80% of total billed charges ,169.8,24.24,,,percent of total billed charges,24.24% of total billed charges ,353.05,50.4,,,percent of total billed charges,50.4% of total billed charges ,525.38,75,,,percent of total billed charges,75% of total billed charges ,171.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,188.15,26.86,,,percent of total billed charges,26.86% of total billed charges,168.12,24,,,percent of total billed charges,24% of total billed charges ,218.56,31.2,,,percent of total billed charges,31.2% of total billed charges,560.4,80,,,percent of total billed charges,80% of total billed charges,168.12,24,,,percent of total billed charges,24% of total billed charges ,168.12,24,,,percent of total billed charges,24% of total billed charges ,168.12,560.4,
EXELON (RIVASTIGMINE) 1.5MG CAP,7055845,CDM,250,RC,,,Outpatient,,,36,18,,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,28.8,80,,,percent of total billed charges,80% of total billed charges ,8.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,18.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,27,75,,,percent of total billed charges,75% of total billed charges ,8.81,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.67,26.86,,,percent of total billed charges,26.86% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,11.23,31.2,,,percent of total billed charges,31.2% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,24,,,percent of total billed charges,24% of total billed charges ,8.64,28.8,
D5W (DEXTROSE 5% ) 100ML IVPB,7055848,CDM,636,RC,J7060,HCPCS,Outpatient,,,44.5,22.25,,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.6,80,,,percent of total billed charges,80% of total billed charges ,10.79,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,33.38,75,,,percent of total billed charges,75% of total billed charges ,10.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.68,24,,,percent of total billed charges,24% of total billed charges ,13.88,31.2,,,percent of total billed charges,31.2% of total billed charges,35.6,80,,,percent of total billed charges,80% of total billed charges,10.68,24,,,percent of total billed charges,24% of total billed charges ,10.68,24,,,percent of total billed charges,24% of total billed charges ,1.93,35.6,
ZZZNUBAIN (NALBUPHINE) 10MG/ML INJ,7055850,CDM,636,RC,J2300,HCPCS,Outpatient,,,35,17.5,,2.81,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.4,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28,80,,,percent of total billed charges,80% of total billed charges ,8.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,2.81,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.4,24,,,percent of total billed charges,24% of total billed charges ,10.92,31.2,,,percent of total billed charges,31.2% of total billed charges,28,80,,,percent of total billed charges,80% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,2.81,28,
PROTONIX (PANTOPRAZOLE DR) 40MG TB,7055851,CDM,250,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
ZANAFLEX (TIZANIDINE HCL) 4MG TAB,7055855,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
TOPAMAX (TOPIRAMATE) 100MG TAB,7055863,CDM,250,RC,,,Outpatient,,,42,21,,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,33.6,80,,,percent of total billed charges,80% of total billed charges ,10.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,13.1,31.2,,,percent of total billed charges,31.2% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,33.6,
FOSOMAX (ALENDRONATE) 35MG TAB,7055865,CDM,250,RC,,,Outpatient,,,110,55,,29.55,26.86,,,percent of total billed charges,26.86% of total billed charges,82.5,75,,,percent of total billed charges,75% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,88,80,,,percent of total billed charges,80% of total billed charges ,26.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,82.5,75,,,percent of total billed charges,75% of total billed charges ,26.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.55,26.86,,,percent of total billed charges,26.86% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,34.32,31.2,,,percent of total billed charges,31.2% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,24,,,percent of total billed charges,24% of total billed charges ,26.4,88,
MORPHINE SULFATE ORAL 10MG/5ML UD,7055866,CDM,250,RC,,,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
KEPPRA (LEVETIRACETAM) 500MG TAB,7055868,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZCYCLOGEL (CYCLOPENTOLATE) 1% O.S.,7055870,CDM,250,RC,,,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
SORBITOL 70% SOLUTION 30ML,7055879,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
ZZZPROPARACAINE 0.5% OPTH SOLN,7055883,CDM,250,RC,,,Outpatient,,,221.5,110.75,,59.49,26.86,,,percent of total billed charges,26.86% of total billed charges,166.13,75,,,percent of total billed charges,75% of total billed charges ,166.13,75,,,percent of total billed charges,75% of total billed charges ,53.16,24,,,percent of total billed charges,24% of total billed charges ,166.13,75,,,percent of total billed charges,75% of total billed charges ,166.13,75,,,percent of total billed charges,75% of total billed charges ,177.2,80,,,percent of total billed charges,80% of total billed charges ,53.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,111.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,166.13,75,,,percent of total billed charges,75% of total billed charges ,54.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,59.49,26.86,,,percent of total billed charges,26.86% of total billed charges,53.16,24,,,percent of total billed charges,24% of total billed charges ,69.11,31.2,,,percent of total billed charges,31.2% of total billed charges,177.2,80,,,percent of total billed charges,80% of total billed charges,53.16,24,,,percent of total billed charges,24% of total billed charges ,53.16,24,,,percent of total billed charges,24% of total billed charges ,53.16,177.2,
ZZZBETADINE (POVIDONE-IODINE) 5% OPTH,7055885,CDM,250,RC,,,Outpatient,,,1510,755,,405.59,26.86,,,percent of total billed charges,26.86% of total billed charges,1132.5,75,,,percent of total billed charges,75% of total billed charges ,1132.5,75,,,percent of total billed charges,75% of total billed charges ,362.4,24,,,percent of total billed charges,24% of total billed charges ,1132.5,75,,,percent of total billed charges,75% of total billed charges ,1132.5,75,,,percent of total billed charges,75% of total billed charges ,1208,80,,,percent of total billed charges,80% of total billed charges ,366.02,24.24,,,percent of total billed charges,24.24% of total billed charges ,761.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,1132.5,75,,,percent of total billed charges,75% of total billed charges ,369.65,24.48,,,percent of total billed charges,24.48% of total billed charges ,405.59,26.86,,,percent of total billed charges,26.86% of total billed charges,362.4,24,,,percent of total billed charges,24% of total billed charges ,471.12,31.2,,,percent of total billed charges,31.2% of total billed charges,1208,80,,,percent of total billed charges,80% of total billed charges,362.4,24,,,percent of total billed charges,24% of total billed charges ,362.4,24,,,percent of total billed charges,24% of total billed charges ,362.4,1208,
PLETAL (CILOSTAZOL) 100MG TAB,7055890,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
SANTYL (COLLAGENASE) OINT 30GM,7055892,CDM,250,RC,,,Outpatient,,,1370,685,,367.98,26.86,,,percent of total billed charges,26.86% of total billed charges,1027.5,75,,,percent of total billed charges,75% of total billed charges ,1027.5,75,,,percent of total billed charges,75% of total billed charges ,328.8,24,,,percent of total billed charges,24% of total billed charges ,1027.5,75,,,percent of total billed charges,75% of total billed charges ,1027.5,75,,,percent of total billed charges,75% of total billed charges ,1096,80,,,percent of total billed charges,80% of total billed charges ,332.09,24.24,,,percent of total billed charges,24.24% of total billed charges ,690.48,50.4,,,percent of total billed charges,50.4% of total billed charges ,1027.5,75,,,percent of total billed charges,75% of total billed charges ,335.38,24.48,,,percent of total billed charges,24.48% of total billed charges ,367.98,26.86,,,percent of total billed charges,26.86% of total billed charges,328.8,24,,,percent of total billed charges,24% of total billed charges ,427.44,31.2,,,percent of total billed charges,31.2% of total billed charges,1096,80,,,percent of total billed charges,80% of total billed charges,328.8,24,,,percent of total billed charges,24% of total billed charges ,328.8,24,,,percent of total billed charges,24% of total billed charges ,328.8,1096,
S2 RACEPINEPHRINE 2.25 % NEB SOL UD,7055893,CDM,250,RC,,,Outpatient,,,15.5,7.75,,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,12.4,80,,,percent of total billed charges,80% of total billed charges ,3.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,11.63,75,,,percent of total billed charges,75% of total billed charges ,3.79,24.48,,,percent of total billed charges,24.48% of total billed charges ,4.16,26.86,,,percent of total billed charges,26.86% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,4.84,31.2,,,percent of total billed charges,31.2% of total billed charges,12.4,80,,,percent of total billed charges,80% of total billed charges,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,24,,,percent of total billed charges,24% of total billed charges ,3.72,12.4,
LIDODERM (LIDOCAINE) 5% PATCH,7055896,CDM,250,RC,,,Outpatient,,,62,31,,16.65,26.86,,,percent of total billed charges,26.86% of total billed charges,46.5,75,,,percent of total billed charges,75% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,14.88,24,,,percent of total billed charges,24% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,49.6,80,,,percent of total billed charges,80% of total billed charges ,15.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,46.5,75,,,percent of total billed charges,75% of total billed charges ,15.18,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.65,26.86,,,percent of total billed charges,26.86% of total billed charges,14.88,24,,,percent of total billed charges,24% of total billed charges ,19.34,31.2,,,percent of total billed charges,31.2% of total billed charges,49.6,80,,,percent of total billed charges,80% of total billed charges,14.88,24,,,percent of total billed charges,24% of total billed charges ,14.88,24,,,percent of total billed charges,24% of total billed charges ,14.88,49.6,
INSULIN-LONG ACTING (LANTUS) VIAL,7055902,CDM,250,RC,,,Outpatient,,,1,0.5,,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.8,80,,,percent of total billed charges,80% of total billed charges ,0.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,0.5,50.4,,,percent of total billed charges,50.4% of total billed charges ,0.75,75,,,percent of total billed charges,75% of total billed charges ,0.24,24.48,,,percent of total billed charges,24.48% of total billed charges ,0.27,26.86,,,percent of total billed charges,26.86% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.31,31.2,,,percent of total billed charges,31.2% of total billed charges,0.8,80,,,percent of total billed charges,80% of total billed charges,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,24,,,percent of total billed charges,24% of total billed charges ,0.24,0.8,
ZZZPATANOL (OLOPATAD) 0.1 % OPH SOLN,7055904,CDM,250,RC,,,Outpatient,,,1101,550.5,,295.73,26.86,,,percent of total billed charges,26.86% of total billed charges,825.75,75,,,percent of total billed charges,75% of total billed charges ,825.75,75,,,percent of total billed charges,75% of total billed charges ,264.24,24,,,percent of total billed charges,24% of total billed charges ,825.75,75,,,percent of total billed charges,75% of total billed charges ,825.75,75,,,percent of total billed charges,75% of total billed charges ,880.8,80,,,percent of total billed charges,80% of total billed charges ,266.88,24.24,,,percent of total billed charges,24.24% of total billed charges ,554.9,50.4,,,percent of total billed charges,50.4% of total billed charges ,825.75,75,,,percent of total billed charges,75% of total billed charges ,269.52,24.48,,,percent of total billed charges,24.48% of total billed charges ,295.73,26.86,,,percent of total billed charges,26.86% of total billed charges,264.24,24,,,percent of total billed charges,24% of total billed charges ,343.51,31.2,,,percent of total billed charges,31.2% of total billed charges,880.8,80,,,percent of total billed charges,80% of total billed charges,264.24,24,,,percent of total billed charges,24% of total billed charges ,264.24,24,,,percent of total billed charges,24% of total billed charges ,264.24,880.8,
ZZZTRILAFON (PERPHENAZINE) 2MG TAB,7055907,CDM,250,RC,,,Outpatient,,,14.5,7.25,,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,11.6,80,,,percent of total billed charges,80% of total billed charges ,3.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,7.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,10.88,75,,,percent of total billed charges,75% of total billed charges ,3.55,24.48,,,percent of total billed charges,24.48% of total billed charges ,3.89,26.86,,,percent of total billed charges,26.86% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,4.52,31.2,,,percent of total billed charges,31.2% of total billed charges,11.6,80,,,percent of total billed charges,80% of total billed charges,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,24,,,percent of total billed charges,24% of total billed charges ,3.48,11.6,
XOPENEX 1.25MG/3ML (LEVALBUTEROL),7055908,CDM,250,RC,,,Outpatient,,,42,21,,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,33.6,80,,,percent of total billed charges,80% of total billed charges ,10.18,24.24,,,percent of total billed charges,24.24% of total billed charges ,21.17,50.4,,,percent of total billed charges,50.4% of total billed charges ,31.5,75,,,percent of total billed charges,75% of total billed charges ,10.28,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.28,26.86,,,percent of total billed charges,26.86% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,13.1,31.2,,,percent of total billed charges,31.2% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,24,,,percent of total billed charges,24% of total billed charges ,10.08,33.6,
ZZZDEMADEX (TORSEMIDE) 20MG/2ML VIAL,7055909,CDM,636,RC,J3265,HCPCS,Outpatient,,,73,36.5,,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.52,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,58.4,
ZYVOX (LINEZOLID) 600MG TAB,7055916,CDM,250,RC,,,Outpatient,,,32,16,,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,25.6,80,,,percent of total billed charges,80% of total billed charges ,7.76,24.24,,,percent of total billed charges,24.24% of total billed charges ,16.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,24,75,,,percent of total billed charges,75% of total billed charges ,7.83,24.48,,,percent of total billed charges,24.48% of total billed charges ,8.6,26.86,,,percent of total billed charges,26.86% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,9.98,31.2,,,percent of total billed charges,31.2% of total billed charges,25.6,80,,,percent of total billed charges,80% of total billed charges,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,24,,,percent of total billed charges,24% of total billed charges ,7.68,25.6,
ZZZADVAIR (FLUT/SALM) 250/50 DISKUS,7055918,CDM,250,RC,,,Outpatient,,,700.5,350.25,,188.15,26.86,,,percent of total billed charges,26.86% of total billed charges,525.38,75,,,percent of total billed charges,75% of total billed charges ,525.38,75,,,percent of total billed charges,75% of total billed charges ,168.12,24,,,percent of total billed charges,24% of total billed charges ,525.38,75,,,percent of total billed charges,75% of total billed charges ,525.38,75,,,percent of total billed charges,75% of total billed charges ,560.4,80,,,percent of total billed charges,80% of total billed charges ,169.8,24.24,,,percent of total billed charges,24.24% of total billed charges ,353.05,50.4,,,percent of total billed charges,50.4% of total billed charges ,525.38,75,,,percent of total billed charges,75% of total billed charges ,171.48,24.48,,,percent of total billed charges,24.48% of total billed charges ,188.15,26.86,,,percent of total billed charges,26.86% of total billed charges,168.12,24,,,percent of total billed charges,24% of total billed charges ,218.56,31.2,,,percent of total billed charges,31.2% of total billed charges,560.4,80,,,percent of total billed charges,80% of total billed charges,168.12,24,,,percent of total billed charges,24% of total billed charges ,168.12,24,,,percent of total billed charges,24% of total billed charges ,168.12,560.4,
ZZZTIGAN (TRIMETHOBENZAMIDE ) 200MG/2ML,7055957,CDM,636,RC,J3250,HCPCS,Outpatient,,,194.5,97.25,,47.84,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,155.6,80,,,percent of total billed charges,80% of total billed charges ,47.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,98.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,145.88,75,,,percent of total billed charges,75% of total billed charges ,47.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.84,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,46.68,24,,,percent of total billed charges,24% of total billed charges ,60.68,31.2,,,percent of total billed charges,31.2% of total billed charges,155.6,80,,,percent of total billed charges,80% of total billed charges,46.68,24,,,percent of total billed charges,24% of total billed charges ,46.68,24,,,percent of total billed charges,24% of total billed charges ,46.68,155.6,
SLCO1B1 GENE,7119720,CDM,310,RC,81328,HCPCS,Outpatient,,,339,169.5,,139.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,81.36,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,271.2,80,,,percent of total billed charges,80% of total billed charges ,82.17,24.24,,,percent of total billed charges,24.24% of total billed charges ,170.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,254.25,75,,,percent of total billed charges,75% of total billed charges ,82.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,139.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,81.36,24,,,percent of total billed charges,24% of total billed charges ,105.77,31.2,,,percent of total billed charges,31.2% of total billed charges,271.2,80,,,percent of total billed charges,80% of total billed charges,81.36,24,,,percent of total billed charges,24% of total billed charges ,81.36,24,,,percent of total billed charges,24% of total billed charges ,81.36,271.2,
TX WT BRG ARTCLR PRTN DSTL TIBIA W/O MAN,7330736,CDM,450,RC,27824,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,710,75,,,percent of total billed charges,75% of total billed charges ,710,75,,,percent of total billed charges,75% of total billed charges ,,,,,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,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,710,710,
HOSP ANESTHESIA 1ST 30 MIN,8040007,CDM,370,RC,,,Outpatient,,,1412,706,,379.26,26.86,,,percent of total billed charges,26.86% of total billed charges,1059,75,,,percent of total billed charges,75% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,338.88,24,,,percent of total billed charges,24% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,1129.6,80,,,percent of total billed charges,80% of total billed charges ,342.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,711.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,1059,75,,,percent of total billed charges,75% of total billed charges ,345.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,379.26,26.86,,,percent of total billed charges,26.86% of total billed charges,338.88,24,,,percent of total billed charges,24% of total billed charges ,440.54,31.2,,,percent of total billed charges,31.2% of total billed charges,1129.6,80,,,percent of total billed charges,80% of total billed charges,338.88,24,,,percent of total billed charges,24% of total billed charges ,338.88,24,,,percent of total billed charges,24% of total billed charges ,338.88,1129.6,
HOSP ANESTHESIA 1/4HR  ADDITIONAL,8040008,CDM,370,RC,,,Outpatient,,,237,118.5,,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,189.6,80,,,percent of total billed charges,80% of total billed charges ,57.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,119.45,50.4,,,percent of total billed charges,50.4% of total billed charges ,177.75,75,,,percent of total billed charges,75% of total billed charges ,58.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,63.66,26.86,,,percent of total billed charges,26.86% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,73.94,31.2,,,percent of total billed charges,31.2% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,24,,,percent of total billed charges,24% of total billed charges ,56.88,189.6,
ANESTHESIA SERVICES,8040009,CDM,370,RC,45384,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA UNITS,8040010,CDM,370,RC,45384,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
BREAST BIOPSY,8040011,CDM,360,RC,400,HCPCS,Outpatient,,,21.5,10.75,,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.2,80,,,percent of total billed charges,80% of total billed charges ,5.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,10.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,16.13,75,,,percent of total billed charges,75% of total billed charges ,5.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.77,26.86,,,percent of total billed charges,26.86% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,6.71,31.2,,,percent of total billed charges,31.2% of total billed charges,17.2,80,,,percent of total billed charges,80% of total billed charges,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,24,,,percent of total billed charges,24% of total billed charges ,5.16,17.2,
ANES INTEG MUSC&NRV HEAD NCK&POSTERIOR T,8040018,CDM,370,RC,300,HCPCS,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
ANES ESOPH THYRD LARYNX TRACH & LYMPH NE,8040019,CDM,370,RC,320,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANES INTEG EXTREMITIES ANT TRUNK & PERIN,8040020,CDM,370,RC,400,HCPCS,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
ANESTHESIA RECONSTRUCTION BREAST,8040021,CDM,370,RC,402,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA RADICAL/MODIFIED RADICAL BREA,8040022,CDM,370,RC,404,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA CLOSED CHEST W/BRONCHOSCOPY N,8040024,CDM,370,RC,520,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA ACCESS CENTRAL VENOUS CIRCULA,8040025,CDM,370,RC,532,HCPCS,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
ANESTHESIA LUMBAR REGION NOS,8040026,CDM,370,RC,630,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA UPPER ANTERIOR ABDOMINAL WALL,8040027,CDM,370,RC,700,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA UPPER POSTERIOR ABDOMINAL WAL,8040028,CDM,370,RC,730,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANES UPPER GI ENDOSCOPY PROXIMAL TO DUOD,8040029,CDM,370,RC,731,HCPCS,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
ANESTHESIA HERNIA REPAIR UPPER ABDOMEN N,8040030,CDM,370,RC,750,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANES INTRAPERITONEAL UPPER ABDOMEN W/LAP,8040032,CDM,370,RC,790,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA LOWER ANTERIOR ABDOMINAL WALL,8040033,CDM,370,RC,800,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANES LOWER INTESTINE ENDOSCOPY DISTAL DU,8040034,CDM,370,RC,811,HCPCS,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
ANESTHESIA LOWER POSTERIOR ABDOMINAL WAL,8040035,CDM,370,RC,820,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA HERNIA REPAIR LOWER ABDOMEN N,8040036,CDM,370,RC,830,HCPCS,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
ANESTHESIA INTRAPERITONEAL LOWER ABD W/L,8040037,CDM,370,RC,840,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANES EXTRAPERITONEAL LWR ABD W/URINARY T,8040038,CDM,370,RC,860,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA ANORECTAL PROCEDURE,8040039,CDM,370,RC,902,HCPCS,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
ANESTHESIA VAGINAL PROCEDURE W/BIOPSY NO,8040040,CDM,370,RC,940,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA OPEN PROCEDURES LOWER 1/3 FEM,8040044,CDM,370,RC,1360,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANES NRV/MUS/TND/FASC LOWER LEG/ANKLE/FO,8040045,CDM,370,RC,1470,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA ARTERIES UPPER ARM & ELBOW NO,8040047,CDM,370,RC,1770,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANES NERVE MUSCLE TDN FSCA&BRS F/ARM WRS,8040048,CDM,370,RC,1810,HCPCS,Outpatient,,,34,17,,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.16,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.2,80,,,percent of total billed charges,80% of total billed charges ,8.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,25.5,75,,,percent of total billed charges,75% of total billed charges ,8.32,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.13,26.86,,,percent of total billed charges,26.86% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,10.61,31.2,,,percent of total billed charges,31.2% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,24,,,percent of total billed charges,24% of total billed charges ,8.16,27.2,
ANESTHESIA ARTERIES FOREARM WRIST & HAND,8040049,CDM,370,RC,1840,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA VASCULAR SHUNT/SHUNT REVISION,8040051,CDM,370,RC,1844,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA VEINS FOREARM WRIST & HAND NO,8040052,CDM,370,RC,1850,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA UPPER 2/3 FEMUR AMPUTATION,8040055,CDM,370,RC,1232,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANES MANIPULATE SPINE/CLSD CRV THORC/LUM,8040056,CDM,370,RC,640,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA MALE GENITALIA INCL OPEN URET,8040057,CDM,370,RC,920,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA VAGINAL HYSTERECTOMY INCL BIO,8040059,CDM,370,RC,944,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANES HRNA RPR UPR ABD LMBR&VNT HRNAS&/WN,8040061,CDM,370,RC,752,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
ANESTHESIA VEINS OF LOWER LEG NOS,8040063,CDM,370,RC,1520,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,24,,,percent of total billed charges,24% of total billed charges ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges ,4.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,4.77,24.48,,,percent of total billed charges,24.48% of total billed charges ,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,6.08,31.2,,,percent of total billed charges,31.2% of total billed charges,15.6,80,,,percent of total billed charges,80% of total billed charges,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,24,,,percent of total billed charges,24% of total billed charges ,4.68,15.6,
TEMPERAL ARTERY BIOPSY,8041843,CDM,361,RC,37609,HCPCS,Outpatient,,,543,271.5,,145.85,26.86,,,percent of total billed charges,26.86% of total billed charges,407.25,75,,,percent of total billed charges,75% of total billed charges ,407.25,75,,,percent of total billed charges,75% of total billed charges ,130.32,24,,,percent of total billed charges,24% of total billed charges ,407.25,75,,,percent of total billed charges,75% of total billed charges ,407.25,75,,,percent of total billed charges,75% of total billed charges ,434.4,80,,,percent of total billed charges,80% of total billed charges ,131.62,24.24,,,percent of total billed charges,24.24% of total billed charges ,273.67,50.4,,,percent of total billed charges,50.4% of total billed charges ,407.25,75,,,percent of total billed charges,75% of total billed charges ,132.93,24.48,,,percent of total billed charges,24.48% of total billed charges ,145.85,26.86,,,percent of total billed charges,26.86% of total billed charges,130.32,24,,,percent of total billed charges,24% of total billed charges ,169.42,31.2,,,percent of total billed charges,31.2% of total billed charges,434.4,80,,,percent of total billed charges,80% of total billed charges,130.32,24,,,percent of total billed charges,24% of total billed charges ,130.32,24,,,percent of total billed charges,24% of total billed charges ,130.32,434.4,
PT PRE-EMPLOY SCREEN,9120000,CDM,420,RC,97799,HCPCS,Outpatient,,,63,31.5,,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,50.4,
PT COGNITIVE TRNING,9120738,CDM,420,RC,97129,HCPCS,Outpatient,,,111,55.5,,29.81,26.86,,,percent of total billed charges,26.86% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges ,83.25,75,,,percent of total billed charges,75% of total billed charges ,26.64,24,,,percent of total billed charges,24% of total billed charges ,83.25,75,,,percent of total billed charges,75% of total billed charges ,83.25,75,,,percent of total billed charges,75% of total billed charges ,88.8,80,,,percent of total billed charges,80% of total billed charges ,26.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,55.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,83.25,75,,,percent of total billed charges,75% of total billed charges ,27.17,24.48,,,percent of total billed charges,24.48% of total billed charges ,29.81,26.86,,,percent of total billed charges,26.86% of total billed charges,26.64,24,,,percent of total billed charges,24% of total billed charges ,34.63,31.2,,,percent of total billed charges,31.2% of total billed charges,88.8,80,,,percent of total billed charges,80% of total billed charges,26.64,24,,,percent of total billed charges,24% of total billed charges ,26.64,24,,,percent of total billed charges,24% of total billed charges ,26.64,88.8,
PT ORTHOTICS TRNING/FIT,9121002,CDM,420,RC,97760,HCPCS,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
PT COMM/WORK REINT 15 M,9121003,CDM,420,RC,97537,HCPCS,Outpatient,,,69,34.5,,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,55.2,80,,,percent of total billed charges,80% of total billed charges ,16.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,21.53,31.2,,,percent of total billed charges,31.2% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,55.2,
PT CAST REMOVAL,9121007,CDM,420,RC,97139,HCPCS,Outpatient,,,35,17.5,,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,28,80,,,percent of total billed charges,80% of total billed charges ,8.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,17.64,50.4,,,percent of total billed charges,50.4% of total billed charges ,26.25,75,,,percent of total billed charges,75% of total billed charges ,8.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,9.4,26.86,,,percent of total billed charges,26.86% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,10.92,31.2,,,percent of total billed charges,31.2% of total billed charges,28,80,,,percent of total billed charges,80% of total billed charges,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,24,,,percent of total billed charges,24% of total billed charges ,8.4,28,
PT PARAFFIN BATH,9121010,CDM,420,RC,97018,HCPCS,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,41.2,
PT NEUROPROBE,9121011,CDM,420,RC,97032,HCPCS,Outpatient,,,74,37,,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,55.5,75,,,percent of total billed charges,75% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,59.2,80,,,percent of total billed charges,80% of total billed charges ,17.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,18.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,23.09,31.2,,,percent of total billed charges,31.2% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,59.2,
PT TENS INITIAL SET UP,9121013,CDM,420,RC,97032,HCPCS,Outpatient,,,114.5,57.25,,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,91.6,
PT TENS TREATMENT 30MIN,9121015,CDM,420,RC,97014,HCPCS,Outpatient,,,73,36.5,,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,58.4,
PT ULTRASOUND,9121016,CDM,420,RC,97035,HCPCS,Outpatient,,,104,52,,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,83.2,80,,,percent of total billed charges,80% of total billed charges ,25.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,25.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,32.45,31.2,,,percent of total billed charges,31.2% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,83.2,
PT ELECT MUS STIM,9121017,CDM,420,RC,97032,HCPCS,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
PT MOIST HEAT COLD PACK,9121018,CDM,420,RC,97010,HCPCS,Outpatient,,,63,31.5,,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,50.4,
PT PT MASSAGE 15 MIN,9121019,CDM,420,RC,97124,HCPCS,Outpatient,,,73,36.5,,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,58.4,
PT PHONOPHORESIS,9121021,CDM,420,RC,97035,HCPCS,Outpatient,,,63,31.5,,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,50.4,
PT TRACT MECH CERV&PELV,9121022,CDM,420,RC,97012,HCPCS,Outpatient,,,73,36.5,,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,58.4,
PT CRYOTHERAPY,9121023,CDM,420,RC,97010,HCPCS,Outpatient,,,63,31.5,,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,50.4,
PT DIATHERMY,9121024,CDM,420,RC,97024,HCPCS,Outpatient,,,49,24.5,,13.16,26.86,,,percent of total billed charges,26.86% of total billed charges,36.75,75,,,percent of total billed charges,75% of total billed charges ,36.75,75,,,percent of total billed charges,75% of total billed charges ,11.76,24,,,percent of total billed charges,24% of total billed charges ,36.75,75,,,percent of total billed charges,75% of total billed charges ,36.75,75,,,percent of total billed charges,75% of total billed charges ,39.2,80,,,percent of total billed charges,80% of total billed charges ,11.88,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,36.75,75,,,percent of total billed charges,75% of total billed charges ,12,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.16,26.86,,,percent of total billed charges,26.86% of total billed charges,11.76,24,,,percent of total billed charges,24% of total billed charges ,15.29,31.2,,,percent of total billed charges,31.2% of total billed charges,39.2,80,,,percent of total billed charges,80% of total billed charges,11.76,24,,,percent of total billed charges,24% of total billed charges ,11.76,24,,,percent of total billed charges,24% of total billed charges ,11.76,39.2,
PT IONTOPHORESIS,9121028,CDM,420,RC,97033,HCPCS,Outpatient,,,73,36.5,,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,58.4,
PT ULTRAVIOLET,9121030,CDM,420,RC,97028,HCPCS,Outpatient,,,45,22.5,,12.09,26.86,,,percent of total billed charges,26.86% of total billed charges,33.75,75,,,percent of total billed charges,75% of total billed charges ,33.75,75,,,percent of total billed charges,75% of total billed charges ,10.8,24,,,percent of total billed charges,24% of total billed charges ,33.75,75,,,percent of total billed charges,75% of total billed charges ,33.75,75,,,percent of total billed charges,75% of total billed charges ,36,80,,,percent of total billed charges,80% of total billed charges ,10.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,22.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,33.75,75,,,percent of total billed charges,75% of total billed charges ,11.02,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.09,26.86,,,percent of total billed charges,26.86% of total billed charges,10.8,24,,,percent of total billed charges,24% of total billed charges ,14.04,31.2,,,percent of total billed charges,31.2% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,10.8,24,,,percent of total billed charges,24% of total billed charges ,10.8,24,,,percent of total billed charges,24% of total billed charges ,10.8,36,
PT TRAPZ/OVHDFRM(INPT),9121031,CDM,420,RC,97139,HCPCS,Outpatient,,,165,82.5,,44.32,26.86,,,percent of total billed charges,26.86% of total billed charges,123.75,75,,,percent of total billed charges,75% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,39.6,24,,,percent of total billed charges,24% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,132,80,,,percent of total billed charges,80% of total billed charges ,40,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,40.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,44.32,26.86,,,percent of total billed charges,26.86% of total billed charges,39.6,24,,,percent of total billed charges,24% of total billed charges ,51.48,31.2,,,percent of total billed charges,31.2% of total billed charges,132,80,,,percent of total billed charges,80% of total billed charges,39.6,24,,,percent of total billed charges,24% of total billed charges ,39.6,24,,,percent of total billed charges,24% of total billed charges ,39.6,132,
PT TRACT PELVCSETUP IP,9121032,CDM,420,RC,97139,HCPCS,Outpatient,,,184.5,92.25,,49.56,26.86,,,percent of total billed charges,26.86% of total billed charges,138.38,75,,,percent of total billed charges,75% of total billed charges ,138.38,75,,,percent of total billed charges,75% of total billed charges ,44.28,24,,,percent of total billed charges,24% of total billed charges ,138.38,75,,,percent of total billed charges,75% of total billed charges ,138.38,75,,,percent of total billed charges,75% of total billed charges ,147.6,80,,,percent of total billed charges,80% of total billed charges ,44.72,24.24,,,percent of total billed charges,24.24% of total billed charges ,92.99,50.4,,,percent of total billed charges,50.4% of total billed charges ,138.38,75,,,percent of total billed charges,75% of total billed charges ,45.17,24.48,,,percent of total billed charges,24.48% of total billed charges ,49.56,26.86,,,percent of total billed charges,26.86% of total billed charges,44.28,24,,,percent of total billed charges,24% of total billed charges ,57.56,31.2,,,percent of total billed charges,31.2% of total billed charges,147.6,80,,,percent of total billed charges,80% of total billed charges,44.28,24,,,percent of total billed charges,24% of total billed charges ,44.28,24,,,percent of total billed charges,24% of total billed charges ,44.28,147.6,
PT TRACTION 90/90 INPT,9121033,CDM,420,RC,97139,HCPCS,Outpatient,,,206,103,,55.33,26.86,,,percent of total billed charges,26.86% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,164.8,80,,,percent of total billed charges,80% of total billed charges ,49.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,103.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,50.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,55.33,26.86,,,percent of total billed charges,26.86% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,64.27,31.2,,,percent of total billed charges,31.2% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,164.8,
PT BIOFEEDBACK,9121037,CDM,420,RC,90901,HCPCS,Outpatient,,,96,48,,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,76.8,80,,,percent of total billed charges,80% of total billed charges ,23.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,72,75,,,percent of total billed charges,75% of total billed charges ,23.5,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.79,26.86,,,percent of total billed charges,26.86% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,29.95,31.2,,,percent of total billed charges,31.2% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,24,,,percent of total billed charges,24% of total billed charges ,23.04,76.8,
PT THERAPEUTIC EX 15M,9121040,CDM,420,RC,97110,HCPCS,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
PT GAIT TRAIN 0-15 MIN,9121043,CDM,420,RC,97116,HCPCS,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
PT TENS FOLLOW UP,9121047,CDM,420,RC,97014,HCPCS,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
PT TRACTION PELVIC,9121048,CDM,420,RC,97012,HCPCS,Outpatient,,,70,35,,18.8,26.86,,,percent of total billed charges,26.86% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,16.8,24,,,percent of total billed charges,24% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,56,80,,,percent of total billed charges,80% of total billed charges ,16.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,35.28,50.4,,,percent of total billed charges,50.4% of total billed charges ,52.5,75,,,percent of total billed charges,75% of total billed charges ,17.14,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.8,26.86,,,percent of total billed charges,26.86% of total billed charges,16.8,24,,,percent of total billed charges,24% of total billed charges ,21.84,31.2,,,percent of total billed charges,31.2% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,16.8,24,,,percent of total billed charges,24% of total billed charges ,16.8,24,,,percent of total billed charges,24% of total billed charges ,16.8,56,
PT JOINT MOBILIZATION,9121050,CDM,420,RC,97265,HCPCS,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
PT MANUAL THPY-15 MIN,9121051,CDM,420,RC,97140,HCPCS,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
PT MYOFASCIAL RELEASE,9121054,CDM,420,RC,97250,HCPCS,Outpatient,,,104,52,,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,83.2,80,,,percent of total billed charges,80% of total billed charges ,25.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,25.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,32.45,31.2,,,percent of total billed charges,31.2% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,83.2,
PT NEUROMUSCULAR RE-ED,9121055,CDM,420,RC,97112,HCPCS,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
PT BACK SCHOOL,9121057,CDM,420,RC,97530,HCPCS,Outpatient,,,69,34.5,,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,55.2,80,,,percent of total billed charges,80% of total billed charges ,16.73,24.24,,,percent of total billed charges,24.24% of total billed charges ,34.78,50.4,,,percent of total billed charges,50.4% of total billed charges ,51.75,75,,,percent of total billed charges,75% of total billed charges ,16.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,18.53,26.86,,,percent of total billed charges,26.86% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,21.53,31.2,,,percent of total billed charges,31.2% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,24,,,percent of total billed charges,24% of total billed charges ,16.56,55.2,
PT ORTH/PROSTCHECK15MIN,9121058,CDM,420,RC,97763,HCPCS,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
PT ICE MASSAGE 15 MIN,9121060,CDM,420,RC,97124,HCPCS,Outpatient,,,63,31.5,,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,50.4,
PT DRESSINGS-LARGE,9121063,CDM,420,RC,97602,HCPCS,Outpatient,,,104,52,,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,83.2,80,,,percent of total billed charges,80% of total billed charges ,25.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,25.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,32.45,31.2,,,percent of total billed charges,31.2% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,83.2,
PT DRESSINGS-MEDIUM,9121064,CDM,420,RC,97602,HCPCS,Outpatient,,,73,36.5,,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,58.4,
PT DRESSINGS-SMALL,9121065,CDM,420,RC,97602,HCPCS,Outpatient,,,41,20.5,,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,32.8,80,,,percent of total billed charges,80% of total billed charges ,9.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,10.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,12.79,31.2,,,percent of total billed charges,31.2% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,32.8,
PT TRACTION CERVICAL,9121515,CDM,420,RC,97012,HCPCS,Outpatient,,,41,20.5,,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,32.8,80,,,percent of total billed charges,80% of total billed charges ,9.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,20.66,50.4,,,percent of total billed charges,50.4% of total billed charges ,30.75,75,,,percent of total billed charges,75% of total billed charges ,10.04,24.48,,,percent of total billed charges,24.48% of total billed charges ,11.01,26.86,,,percent of total billed charges,26.86% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,12.79,31.2,,,percent of total billed charges,31.2% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,24,,,percent of total billed charges,24% of total billed charges ,9.84,32.8,
PT TRACTCERV(INPT)SETUP,9122001,CDM,420,RC,97139,HCPCS,Outpatient,,,206,103,,55.33,26.86,,,percent of total billed charges,26.86% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,164.8,80,,,percent of total billed charges,80% of total billed charges ,49.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,103.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,50.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,55.33,26.86,,,percent of total billed charges,26.86% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,64.27,31.2,,,percent of total billed charges,31.2% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,164.8,
PT TRACT RECHK&ADJ INPT,9122003,CDM,420,RC,97139,HCPCS,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
PT EXT WP,9123001,CDM,420,RC,97022,HCPCS,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
PT FULL BODY WP,9123003,CDM,420,RC,97022,HCPCS,Outpatient,,,114.5,57.25,,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,91.6,
PT STERILE FULL BODY WP,9123004,CDM,420,RC,97022,HCPCS,Outpatient,,,114.5,57.25,,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,91.6,
PT PT EVALUATION,9127001,CDM,424,RC,97162,HCPCS,Outpatient,,,310,155,,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,74.4,24,,,percent of total billed charges,24% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,248,80,,,percent of total billed charges,80% of total billed charges ,75.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,156.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,75.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,74.4,24,,,percent of total billed charges,24% of total billed charges ,96.72,31.2,,,percent of total billed charges,31.2% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,74.4,24,,,percent of total billed charges,24% of total billed charges ,74.4,24,,,percent of total billed charges,24% of total billed charges ,74.4,248,
PT LIMB MUSCLE TESTING,9127002,CDM,420,RC,95851,HCPCS,Outpatient,,,78,39,,20.95,26.86,,,percent of total billed charges,26.86% of total billed charges,58.5,75,,,percent of total billed charges,75% of total billed charges ,58.5,75,,,percent of total billed charges,75% of total billed charges ,18.72,24,,,percent of total billed charges,24% of total billed charges ,58.5,75,,,percent of total billed charges,75% of total billed charges ,58.5,75,,,percent of total billed charges,75% of total billed charges ,62.4,80,,,percent of total billed charges,80% of total billed charges ,18.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.31,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.5,75,,,percent of total billed charges,75% of total billed charges ,19.09,24.48,,,percent of total billed charges,24.48% of total billed charges ,20.95,26.86,,,percent of total billed charges,26.86% of total billed charges,18.72,24,,,percent of total billed charges,24% of total billed charges ,24.34,31.2,,,percent of total billed charges,31.2% of total billed charges,62.4,80,,,percent of total billed charges,80% of total billed charges,18.72,24,,,percent of total billed charges,24% of total billed charges ,18.72,24,,,percent of total billed charges,24% of total billed charges ,18.72,62.4,
PT FUNCTIONAL EVALUATIO,9127004,CDM,420,RC,99203,HCPCS,Outpatient,,,86,43,,23.1,26.86,,,percent of total billed charges,26.86% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges ,64.5,75,,,percent of total billed charges,75% of total billed charges ,20.64,24,,,percent of total billed charges,24% of total billed charges ,64.5,75,,,percent of total billed charges,75% of total billed charges ,64.5,75,,,percent of total billed charges,75% of total billed charges ,68.8,80,,,percent of total billed charges,80% of total billed charges ,20.85,24.24,,,percent of total billed charges,24.24% of total billed charges ,43.34,50.4,,,percent of total billed charges,50.4% of total billed charges ,64.5,75,,,percent of total billed charges,75% of total billed charges ,21.05,24.48,,,percent of total billed charges,24.48% of total billed charges ,23.1,26.86,,,percent of total billed charges,26.86% of total billed charges,20.64,24,,,percent of total billed charges,24% of total billed charges ,26.83,31.2,,,percent of total billed charges,31.2% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,20.64,24,,,percent of total billed charges,24% of total billed charges ,20.64,24,,,percent of total billed charges,24% of total billed charges ,20.64,68.8,
PT ADL TRAINING,9127006,CDM,420,RC,97535,HCPCS,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
PT POSTURE ANALY TEACH,9127007,CDM,420,RC,97530,HCPCS,Outpatient,,,54.5,27.25,,14.64,26.86,,,percent of total billed charges,26.86% of total billed charges,40.88,75,,,percent of total billed charges,75% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,13.08,24,,,percent of total billed charges,24% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,43.6,80,,,percent of total billed charges,80% of total billed charges ,13.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,27.47,50.4,,,percent of total billed charges,50.4% of total billed charges ,40.88,75,,,percent of total billed charges,75% of total billed charges ,13.34,24.48,,,percent of total billed charges,24.48% of total billed charges ,14.64,26.86,,,percent of total billed charges,26.86% of total billed charges,13.08,24,,,percent of total billed charges,24% of total billed charges ,17,31.2,,,percent of total billed charges,31.2% of total billed charges,43.6,80,,,percent of total billed charges,80% of total billed charges,13.08,24,,,percent of total billed charges,24% of total billed charges ,13.08,24,,,percent of total billed charges,24% of total billed charges ,13.08,43.6,
PT DEBRIDEMENT NONSELEC,9127008,CDM,420,RC,97602,HCPCS,Outpatient,,,122.5,61.25,,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,98,80,,,percent of total billed charges,80% of total billed charges ,29.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,38.22,31.2,,,percent of total billed charges,31.2% of total billed charges,98,80,,,percent of total billed charges,80% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,98,
PT DEBRIDEMENT < 20CM,9127009,CDM,420,RC,97597,HCPCS,Outpatient,,,154.5,77.25,,41.5,26.86,,,percent of total billed charges,26.86% of total billed charges,115.88,75,,,percent of total billed charges,75% of total billed charges ,115.88,75,,,percent of total billed charges,75% of total billed charges ,37.08,24,,,percent of total billed charges,24% of total billed charges ,115.88,75,,,percent of total billed charges,75% of total billed charges ,115.88,75,,,percent of total billed charges,75% of total billed charges ,123.6,80,,,percent of total billed charges,80% of total billed charges ,37.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,77.87,50.4,,,percent of total billed charges,50.4% of total billed charges ,115.88,75,,,percent of total billed charges,75% of total billed charges ,37.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,41.5,26.86,,,percent of total billed charges,26.86% of total billed charges,37.08,24,,,percent of total billed charges,24% of total billed charges ,48.2,31.2,,,percent of total billed charges,31.2% of total billed charges,123.6,80,,,percent of total billed charges,80% of total billed charges,37.08,24,,,percent of total billed charges,24% of total billed charges ,37.08,24,,,percent of total billed charges,24% of total billed charges ,37.08,123.6,
PT DEBRIDEMENT >20CM,9127010,CDM,420,RC,97598,HCPCS,Outpatient,,,176,88,,47.27,26.86,,,percent of total billed charges,26.86% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,42.24,24,,,percent of total billed charges,24% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,140.8,80,,,percent of total billed charges,80% of total billed charges ,42.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,88.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,43.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.27,26.86,,,percent of total billed charges,26.86% of total billed charges,42.24,24,,,percent of total billed charges,24% of total billed charges ,54.91,31.2,,,percent of total billed charges,31.2% of total billed charges,140.8,80,,,percent of total billed charges,80% of total billed charges,42.24,24,,,percent of total billed charges,24% of total billed charges ,42.24,24,,,percent of total billed charges,24% of total billed charges ,42.24,140.8,
PT EVAL: LOW COMPLEXITY,9127020,CDM,424,RC,97161,HCPCS,Outpatient,,,310,155,,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,74.4,24,,,percent of total billed charges,24% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,248,80,,,percent of total billed charges,80% of total billed charges ,75.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,156.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,75.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,74.4,24,,,percent of total billed charges,24% of total billed charges ,96.72,31.2,,,percent of total billed charges,31.2% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,74.4,24,,,percent of total billed charges,24% of total billed charges ,74.4,24,,,percent of total billed charges,24% of total billed charges ,74.4,248,
PT EVAL: MODERATE COMPLEXITY,9127021,CDM,424,RC,97162,HCPCS,Outpatient,,,310,155,,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,74.4,24,,,percent of total billed charges,24% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,248,80,,,percent of total billed charges,80% of total billed charges ,75.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,156.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,75.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,74.4,24,,,percent of total billed charges,24% of total billed charges ,96.72,31.2,,,percent of total billed charges,31.2% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,74.4,24,,,percent of total billed charges,24% of total billed charges ,74.4,24,,,percent of total billed charges,24% of total billed charges ,74.4,248,
PT EVAL: HIGH COMPLEXITY,9127022,CDM,424,RC,97163,HCPCS,Outpatient,,,310,155,,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,74.4,24,,,percent of total billed charges,24% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,248,80,,,percent of total billed charges,80% of total billed charges ,75.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,156.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,75.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,74.4,24,,,percent of total billed charges,24% of total billed charges ,96.72,31.2,,,percent of total billed charges,31.2% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,74.4,24,,,percent of total billed charges,24% of total billed charges ,74.4,24,,,percent of total billed charges,24% of total billed charges ,74.4,248,
PT PT RE-EVALUATION,9127026,CDM,420,RC,97164,HCPCS,Outpatient,,,146,73,,39.22,26.86,,,percent of total billed charges,26.86% of total billed charges,109.5,75,,,percent of total billed charges,75% of total billed charges ,109.5,75,,,percent of total billed charges,75% of total billed charges ,35.04,24,,,percent of total billed charges,24% of total billed charges ,109.5,75,,,percent of total billed charges,75% of total billed charges ,109.5,75,,,percent of total billed charges,75% of total billed charges ,116.8,80,,,percent of total billed charges,80% of total billed charges ,35.39,24.24,,,percent of total billed charges,24.24% of total billed charges ,73.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,109.5,75,,,percent of total billed charges,75% of total billed charges ,35.74,24.48,,,percent of total billed charges,24.48% of total billed charges ,39.22,26.86,,,percent of total billed charges,26.86% of total billed charges,35.04,24,,,percent of total billed charges,24% of total billed charges ,45.55,31.2,,,percent of total billed charges,31.2% of total billed charges,116.8,80,,,percent of total billed charges,80% of total billed charges,35.04,24,,,percent of total billed charges,24% of total billed charges ,35.04,24,,,percent of total billed charges,24% of total billed charges ,35.04,116.8,
PT CONTRAST BATH,9127027,CDM,420,RC,97034,HCPCS,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,41.2,
PT THERAP ACTIV-15 MIN,9127028,CDM,420,RC,97530,HCPCS,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
PT WHEELCHAIR MGT/PROP,9127029,CDM,420,RC,97542,HCPCS,Outpatient,,,73,36.5,,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,58.4,
PT WORK HARDENING 2HRS,9127030,CDM,420,RC,97545,HCPCS,Outpatient,,,206,103,,55.33,26.86,,,percent of total billed charges,26.86% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,164.8,80,,,percent of total billed charges,80% of total billed charges ,49.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,103.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,50.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,55.33,26.86,,,percent of total billed charges,26.86% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,64.27,31.2,,,percent of total billed charges,31.2% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,164.8,
PT WORK HARDENING/COND,9127031,CDM,420,RC,97546,HCPCS,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
PT PHYSICAL PERF TEST,9127032,CDM,420,RC,97750,HCPCS,Outpatient,,,114.5,57.25,,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,91.6,
PT PULSIVAC,9127033,CDM,420,RC,97022,HCPCS,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
PT MUSCLE TEST HAND,9127034,CDM,420,RC,95852,HCPCS,Outpatient,,,73,36.5,,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,58.4,
PT MUSCLE TEST BODY W/O,9127035,CDM,420,RC,95851,HCPCS,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
PT MUSCL TST BODY&HANDS,9127036,CDM,420,RC,97750,HCPCS,Outpatient,,,104,52,,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,83.2,80,,,percent of total billed charges,80% of total billed charges ,25.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,25.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,32.45,31.2,,,percent of total billed charges,31.2% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,83.2,
PT CANALITH REPOSITIONING,9127037,CDM,420,RC,95992,HCPCS,Outpatient,,,148.5,74.25,,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,35.64,24,,,percent of total billed charges,24% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,118.8,80,,,percent of total billed charges,80% of total billed charges ,36,24.24,,,percent of total billed charges,24.24% of total billed charges ,74.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,36.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,35.64,24,,,percent of total billed charges,24% of total billed charges ,46.33,31.2,,,percent of total billed charges,31.2% of total billed charges,118.8,80,,,percent of total billed charges,80% of total billed charges,35.64,24,,,percent of total billed charges,24% of total billed charges ,35.64,24,,,percent of total billed charges,24% of total billed charges ,35.64,118.8,
PT PROSTHETICS TRNING,9127038,CDM,420,RC,97761,HCPCS,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
PT UNNA BOOT APPLICATIO,9127040,CDM,420,RC,29580,HCPCS,Outpatient,,,122.5,61.25,,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,98,80,,,percent of total billed charges,80% of total billed charges ,29.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,38.22,31.2,,,percent of total billed charges,31.2% of total billed charges,98,80,,,percent of total billed charges,80% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,98,
PT SENSORY INTEGRATION,9127042,CDM,420,RC,97533,HCPCS,Outpatient,,,74,37,,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,55.5,75,,,percent of total billed charges,75% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,59.2,80,,,percent of total billed charges,80% of total billed charges ,17.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,37.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,55.5,75,,,percent of total billed charges,75% of total billed charges ,18.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.88,26.86,,,percent of total billed charges,26.86% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,23.09,31.2,,,percent of total billed charges,31.2% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,24,,,percent of total billed charges,24% of total billed charges ,17.76,59.2,
PT UNSPECIFIED TREATMNT,9127043,CDM,420,RC,97139,HCPCS,Outpatient,,,59,29.5,,15.85,26.86,,,percent of total billed charges,26.86% of total billed charges,44.25,75,,,percent of total billed charges,75% of total billed charges ,44.25,75,,,percent of total billed charges,75% of total billed charges ,14.16,24,,,percent of total billed charges,24% of total billed charges ,44.25,75,,,percent of total billed charges,75% of total billed charges ,44.25,75,,,percent of total billed charges,75% of total billed charges ,47.2,80,,,percent of total billed charges,80% of total billed charges ,14.3,24.24,,,percent of total billed charges,24.24% of total billed charges ,29.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,44.25,75,,,percent of total billed charges,75% of total billed charges ,14.44,24.48,,,percent of total billed charges,24.48% of total billed charges ,15.85,26.86,,,percent of total billed charges,26.86% of total billed charges,14.16,24,,,percent of total billed charges,24% of total billed charges ,18.41,31.2,,,percent of total billed charges,31.2% of total billed charges,47.2,80,,,percent of total billed charges,80% of total billed charges,14.16,24,,,percent of total billed charges,24% of total billed charges ,14.16,24,,,percent of total billed charges,24% of total billed charges ,14.16,47.2,
PT CPM DAILY MAINT,9127051,CDM,420,RC,97139,HCPCS,Outpatient,,,49.5,24.75,,13.3,26.86,,,percent of total billed charges,26.86% of total billed charges,37.13,75,,,percent of total billed charges,75% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,11.88,24,,,percent of total billed charges,24% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,39.6,80,,,percent of total billed charges,80% of total billed charges ,12,24.24,,,percent of total billed charges,24.24% of total billed charges ,24.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,37.13,75,,,percent of total billed charges,75% of total billed charges ,12.12,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.3,26.86,,,percent of total billed charges,26.86% of total billed charges,11.88,24,,,percent of total billed charges,24% of total billed charges ,15.44,31.2,,,percent of total billed charges,31.2% of total billed charges,39.6,80,,,percent of total billed charges,80% of total billed charges,11.88,24,,,percent of total billed charges,24% of total billed charges ,11.88,24,,,percent of total billed charges,24% of total billed charges ,11.88,39.6,
PT ESTIM W/WOUND CARE,9127060,CDM,420,RC,G0281,HCPCS,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
PT GROUP - THERAPEUTIC,9127065,CDM,420,RC,97150,HCPCS,Outpatient,,,63,31.5,,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,50.4,
PT EDUC/SELF MGT 1 PATIENT,9127066,CDM,420,RC,98960,HCPCS,Outpatient,,,63,31.5,,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,50.4,
PT EDUC/SELF MGT 2-4 PATIENTS,9127067,CDM,420,RC,98961,HCPCS,Outpatient,,,63,31.5,,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,50.4,
PT EDUC/SELF MGT  5-8 PATIENTS,9127068,CDM,420,RC,98962,HCPCS,Outpatient,,,63,31.5,,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,50.4,
.PT JOBST PUMP -PROCEDUR,9190000,CDM,420,RC,97016,HCPCS,Outpatient,,,73,36.5,,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,58.4,
PT STERILE EXT WP,9190001,CDM,420,RC,97022,HCPCS,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
PT NEG PRES WOUND THERA,9192761,CDM,420,RC,97605,HCPCS,Outpatient,,,199,99.5,,53.45,26.86,,,percent of total billed charges,26.86% of total billed charges,149.25,75,,,percent of total billed charges,75% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,159.2,80,,,percent of total billed charges,80% of total billed charges ,48.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,100.3,50.4,,,percent of total billed charges,50.4% of total billed charges ,149.25,75,,,percent of total billed charges,75% of total billed charges ,48.72,24.48,,,percent of total billed charges,24.48% of total billed charges ,53.45,26.86,,,percent of total billed charges,26.86% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,62.09,31.2,,,percent of total billed charges,31.2% of total billed charges,159.2,80,,,percent of total billed charges,80% of total billed charges,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,24,,,percent of total billed charges,24% of total billed charges ,47.76,159.2,
PT PT EVALUATION WOUND CARE,9192762,CDM,420,RC,97162,HCPCS,Outpatient,,,310,155,,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,74.4,24,,,percent of total billed charges,24% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,248,80,,,percent of total billed charges,80% of total billed charges ,75.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,156.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,75.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,74.4,24,,,percent of total billed charges,24% of total billed charges ,96.72,31.2,,,percent of total billed charges,31.2% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,74.4,24,,,percent of total billed charges,24% of total billed charges ,74.4,24,,,percent of total billed charges,24% of total billed charges ,74.4,248,
ROM MEASURMENTS PT,9192763,CDM,420,RC,95851,HCPCS,Outpatient,,,66,33,,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,52.8,80,,,percent of total billed charges,80% of total billed charges ,16,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,16.16,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,20.59,31.2,,,percent of total billed charges,31.2% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,52.8,
PT MUSCLE TESTING MANUAL MMT,9192764,CDM,420,RC,97750,HCPCS,Outpatient,,,78.5,39.25,,21.09,26.86,,,percent of total billed charges,26.86% of total billed charges,58.88,75,,,percent of total billed charges,75% of total billed charges ,58.88,75,,,percent of total billed charges,75% of total billed charges ,18.84,24,,,percent of total billed charges,24% of total billed charges ,58.88,75,,,percent of total billed charges,75% of total billed charges ,58.88,75,,,percent of total billed charges,75% of total billed charges ,62.8,80,,,percent of total billed charges,80% of total billed charges ,19.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.88,75,,,percent of total billed charges,75% of total billed charges ,19.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.09,26.86,,,percent of total billed charges,26.86% of total billed charges,18.84,24,,,percent of total billed charges,24% of total billed charges ,24.49,31.2,,,percent of total billed charges,31.2% of total billed charges,62.8,80,,,percent of total billed charges,80% of total billed charges,18.84,24,,,percent of total billed charges,24% of total billed charges ,18.84,24,,,percent of total billed charges,24% of total billed charges ,18.84,62.8,
PT MEDICARE ELECT STIM,9192765,CDM,420,RC,G0283,HCPCS,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
OT STRAPPING OF ANKLE,9227001,CDM,430,RC,29540,HCPCS,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
OT STRAPPING OF KNEE,9227002,CDM,430,RC,29530,HCPCS,Outpatient,,,122.5,61.25,,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,98,80,,,percent of total billed charges,80% of total billed charges ,29.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,38.22,31.2,,,percent of total billed charges,31.2% of total billed charges,98,80,,,percent of total billed charges,80% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,98,
OT APP SH ARM SPLINT DY,9227003,CDM,430,RC,29126,HCPCS,Outpatient,,,176,88,,47.27,26.86,,,percent of total billed charges,26.86% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,42.24,24,,,percent of total billed charges,24% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,140.8,80,,,percent of total billed charges,80% of total billed charges ,42.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,88.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,43.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.27,26.86,,,percent of total billed charges,26.86% of total billed charges,42.24,24,,,percent of total billed charges,24% of total billed charges ,54.91,31.2,,,percent of total billed charges,31.2% of total billed charges,140.8,80,,,percent of total billed charges,80% of total billed charges,42.24,24,,,percent of total billed charges,24% of total billed charges ,42.24,24,,,percent of total billed charges,24% of total billed charges ,42.24,140.8,
OT APP SH ARM ST,9227004,CDM,430,RC,29125,HCPCS,Outpatient,,,143,71.5,,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,114.4,80,,,percent of total billed charges,80% of total billed charges ,34.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,35.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,44.62,31.2,,,percent of total billed charges,31.2% of total billed charges,114.4,80,,,percent of total billed charges,80% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,114.4,
OT APL LONG ARM SPLINT,9227005,CDM,430,RC,29105,HCPCS,Outpatient,,,186.5,93.25,,50.09,26.86,,,percent of total billed charges,26.86% of total billed charges,139.88,75,,,percent of total billed charges,75% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,44.76,24,,,percent of total billed charges,24% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,149.2,80,,,percent of total billed charges,80% of total billed charges ,45.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,94,50.4,,,percent of total billed charges,50.4% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,45.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,50.09,26.86,,,percent of total billed charges,26.86% of total billed charges,44.76,24,,,percent of total billed charges,24% of total billed charges ,58.19,31.2,,,percent of total billed charges,31.2% of total billed charges,149.2,80,,,percent of total billed charges,80% of total billed charges,44.76,24,,,percent of total billed charges,24% of total billed charges ,44.76,24,,,percent of total billed charges,24% of total billed charges ,44.76,149.2,
OT APP FINGER SPLINT ST,9227006,CDM,430,RC,29130,HCPCS,Outpatient,,,89.5,44.75,,24.04,26.86,,,percent of total billed charges,26.86% of total billed charges,67.13,75,,,percent of total billed charges,75% of total billed charges ,67.13,75,,,percent of total billed charges,75% of total billed charges ,21.48,24,,,percent of total billed charges,24% of total billed charges ,67.13,75,,,percent of total billed charges,75% of total billed charges ,67.13,75,,,percent of total billed charges,75% of total billed charges ,71.6,80,,,percent of total billed charges,80% of total billed charges ,21.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,45.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,67.13,75,,,percent of total billed charges,75% of total billed charges ,21.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.04,26.86,,,percent of total billed charges,26.86% of total billed charges,21.48,24,,,percent of total billed charges,24% of total billed charges ,27.92,31.2,,,percent of total billed charges,31.2% of total billed charges,71.6,80,,,percent of total billed charges,80% of total billed charges,21.48,24,,,percent of total billed charges,24% of total billed charges ,21.48,24,,,percent of total billed charges,24% of total billed charges ,21.48,71.6,
OTAPP FINGER SPLINT DY,9227007,CDM,430,RC,29131,HCPCS,Outpatient,,,114.5,57.25,,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,91.6,
OT STRAPPING LOW BACK,9227008,CDM,430,RC,,,Outpatient,,,122.5,61.25,,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,98,80,,,percent of total billed charges,80% of total billed charges ,29.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,38.22,31.2,,,percent of total billed charges,31.2% of total billed charges,98,80,,,percent of total billed charges,80% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,98,
OT STRAPPING SHOULDER,9227009,CDM,430,RC,29240,HCPCS,Outpatient,,,144,72,,38.68,26.86,,,percent of total billed charges,26.86% of total billed charges,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,115.2,80,,,percent of total billed charges,80% of total billed charges ,34.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,35.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,38.68,26.86,,,percent of total billed charges,26.86% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,44.93,31.2,,,percent of total billed charges,31.2% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,115.2,
OT STRAPPING ELBOW WRIST,9227010,CDM,430,RC,29260,HCPCS,Outpatient,,,114.5,57.25,,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,91.6,
OT STRAP HAND/FING,9227011,CDM,430,RC,29280,HCPCS,Outpatient,,,114.5,57.25,,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,91.6,
OT APPL LONG ARM SPLINT,9227012,CDM,430,RC,29105,HCPCS,Outpatient,,,186.5,93.25,,50.09,26.86,,,percent of total billed charges,26.86% of total billed charges,139.88,75,,,percent of total billed charges,75% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,44.76,24,,,percent of total billed charges,24% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,149.2,80,,,percent of total billed charges,80% of total billed charges ,45.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,94,50.4,,,percent of total billed charges,50.4% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,45.66,24.48,,,percent of total billed charges,24.48% of total billed charges ,50.09,26.86,,,percent of total billed charges,26.86% of total billed charges,44.76,24,,,percent of total billed charges,24% of total billed charges ,58.19,31.2,,,percent of total billed charges,31.2% of total billed charges,149.2,80,,,percent of total billed charges,80% of total billed charges,44.76,24,,,percent of total billed charges,24% of total billed charges ,44.76,24,,,percent of total billed charges,24% of total billed charges ,44.76,149.2,
OT APP SH ARM SPLINT ST - 29125,9227013,CDM,430,RC,29125,HCPCS,Outpatient,,,143,71.5,,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,114.4,80,,,percent of total billed charges,80% of total billed charges ,34.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,35.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,44.62,31.2,,,percent of total billed charges,31.2% of total billed charges,114.4,80,,,percent of total billed charges,80% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,114.4,
OT APP SH ARM SPLINT DY - 29126,9227014,CDM,430,RC,29126,HCPCS,Outpatient,,,176,88,,47.27,26.86,,,percent of total billed charges,26.86% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,42.24,24,,,percent of total billed charges,24% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,140.8,80,,,percent of total billed charges,80% of total billed charges ,42.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,88.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,132,75,,,percent of total billed charges,75% of total billed charges ,43.08,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.27,26.86,,,percent of total billed charges,26.86% of total billed charges,42.24,24,,,percent of total billed charges,24% of total billed charges ,54.91,31.2,,,percent of total billed charges,31.2% of total billed charges,140.8,80,,,percent of total billed charges,80% of total billed charges,42.24,24,,,percent of total billed charges,24% of total billed charges ,42.24,24,,,percent of total billed charges,24% of total billed charges ,42.24,140.8,
OT APP FINGER SPLINT ST - 29130,9227015,CDM,430,RC,29130,HCPCS,Outpatient,,,89.5,44.75,,24.04,26.86,,,percent of total billed charges,26.86% of total billed charges,67.13,75,,,percent of total billed charges,75% of total billed charges ,67.13,75,,,percent of total billed charges,75% of total billed charges ,21.48,24,,,percent of total billed charges,24% of total billed charges ,67.13,75,,,percent of total billed charges,75% of total billed charges ,67.13,75,,,percent of total billed charges,75% of total billed charges ,71.6,80,,,percent of total billed charges,80% of total billed charges ,21.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,45.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,67.13,75,,,percent of total billed charges,75% of total billed charges ,21.91,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.04,26.86,,,percent of total billed charges,26.86% of total billed charges,21.48,24,,,percent of total billed charges,24% of total billed charges ,27.92,31.2,,,percent of total billed charges,31.2% of total billed charges,71.6,80,,,percent of total billed charges,80% of total billed charges,21.48,24,,,percent of total billed charges,24% of total billed charges ,21.48,24,,,percent of total billed charges,24% of total billed charges ,21.48,71.6,
OT APP FINGER SPLINT DY - 29131,9227016,CDM,430,RC,29131,HCPCS,Outpatient,,,114.5,57.25,,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,91.6,
OT STRAPPING LOW BACK,9227017,CDM,430,RC,29799,HCPCS,Outpatient,,,122.5,61.25,,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,98,80,,,percent of total billed charges,80% of total billed charges ,29.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,38.22,31.2,,,percent of total billed charges,31.2% of total billed charges,98,80,,,percent of total billed charges,80% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,98,
OT STRAPPING SHOULDER,9227018,CDM,430,RC,29240,HCPCS,Outpatient,,,144,72,,38.68,26.86,,,percent of total billed charges,26.86% of total billed charges,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,115.2,80,,,percent of total billed charges,80% of total billed charges ,34.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,35.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,38.68,26.86,,,percent of total billed charges,26.86% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,44.93,31.2,,,percent of total billed charges,31.2% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,115.2,
OT STRAPPING ELBO/WRIS,9227019,CDM,430,RC,29260,HCPCS,Outpatient,,,114.5,57.25,,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,91.6,
OT STRAPPING HAND/FING,9227020,CDM,430,RC,29280,HCPCS,Outpatient,,,114.5,57.25,,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,91.6,
OT APP LONG LEG SPLINT,9227021,CDM,430,RC,29505,HCPCS,Outpatient,,,165,82.5,,44.32,26.86,,,percent of total billed charges,26.86% of total billed charges,123.75,75,,,percent of total billed charges,75% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,39.6,24,,,percent of total billed charges,24% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,132,80,,,percent of total billed charges,80% of total billed charges ,40,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,40.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,44.32,26.86,,,percent of total billed charges,26.86% of total billed charges,39.6,24,,,percent of total billed charges,24% of total billed charges ,51.48,31.2,,,percent of total billed charges,31.2% of total billed charges,132,80,,,percent of total billed charges,80% of total billed charges,39.6,24,,,percent of total billed charges,24% of total billed charges ,39.6,24,,,percent of total billed charges,24% of total billed charges ,39.6,132,
OT APP SHORT LEG SPLINT,9227022,CDM,430,RC,29515,HCPCS,Outpatient,,,144,72,,38.68,26.86,,,percent of total billed charges,26.86% of total billed charges,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,115.2,80,,,percent of total billed charges,80% of total billed charges ,34.91,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,108,75,,,percent of total billed charges,75% of total billed charges ,35.25,24.48,,,percent of total billed charges,24.48% of total billed charges ,38.68,26.86,,,percent of total billed charges,26.86% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,44.93,31.2,,,percent of total billed charges,31.2% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,24,,,percent of total billed charges,24% of total billed charges ,34.56,115.2,
OT STRAPPING HIP,9227023,CDM,430,RC,29520,HCPCS,Outpatient,,,136,68,,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,108.8,80,,,percent of total billed charges,80% of total billed charges ,32.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,33.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,42.43,31.2,,,percent of total billed charges,31.2% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,108.8,
OT STRAPPING OF KNEE,9227024,CDM,430,RC,29530,HCPCS,Outpatient,,,122.5,61.25,,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,98,80,,,percent of total billed charges,80% of total billed charges ,29.69,24.24,,,percent of total billed charges,24.24% of total billed charges ,61.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,91.88,75,,,percent of total billed charges,75% of total billed charges ,29.99,24.48,,,percent of total billed charges,24.48% of total billed charges ,32.9,26.86,,,percent of total billed charges,26.86% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,38.22,31.2,,,percent of total billed charges,31.2% of total billed charges,98,80,,,percent of total billed charges,80% of total billed charges,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,24,,,percent of total billed charges,24% of total billed charges ,29.4,98,
OT STRAPPING OF ANKLE,9227025,CDM,430,RC,29540,HCPCS,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
OT APP LONG LEG SPLINT,9227026,CDM,430,RC,29505,HCPCS,Outpatient,,,165,82.5,,44.32,26.86,,,percent of total billed charges,26.86% of total billed charges,123.75,75,,,percent of total billed charges,75% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,39.6,24,,,percent of total billed charges,24% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,132,80,,,percent of total billed charges,80% of total billed charges ,40,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,40.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,44.32,26.86,,,percent of total billed charges,26.86% of total billed charges,39.6,24,,,percent of total billed charges,24% of total billed charges ,51.48,31.2,,,percent of total billed charges,31.2% of total billed charges,132,80,,,percent of total billed charges,80% of total billed charges,39.6,24,,,percent of total billed charges,24% of total billed charges ,39.6,24,,,percent of total billed charges,24% of total billed charges ,39.6,132,
OT STRAPPING HIP,9227027,CDM,430,RC,29520,HCPCS,Outpatient,,,136,68,,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,108.8,80,,,percent of total billed charges,80% of total billed charges ,32.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,33.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,42.43,31.2,,,percent of total billed charges,31.2% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,108.8,
OT APP SHORT LEG SPLINT,9227028,CDM,430,RC,29515,HCPCS,Outpatient,,,143,71.5,,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,114.4,80,,,percent of total billed charges,80% of total billed charges ,34.66,24.24,,,percent of total billed charges,24.24% of total billed charges ,72.07,50.4,,,percent of total billed charges,50.4% of total billed charges ,107.25,75,,,percent of total billed charges,75% of total billed charges ,35.01,24.48,,,percent of total billed charges,24.48% of total billed charges ,38.41,26.86,,,percent of total billed charges,26.86% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,44.62,31.2,,,percent of total billed charges,31.2% of total billed charges,114.4,80,,,percent of total billed charges,80% of total billed charges,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,24,,,percent of total billed charges,24% of total billed charges ,34.32,114.4,
OT STRAPPING THORAX,9227041,CDM,430,RC,29200,HCPCS,Outpatient,,,136,68,,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,108.8,80,,,percent of total billed charges,80% of total billed charges ,32.97,24.24,,,percent of total billed charges,24.24% of total billed charges ,68.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,102,75,,,percent of total billed charges,75% of total billed charges ,33.29,24.48,,,percent of total billed charges,24.48% of total billed charges ,36.53,26.86,,,percent of total billed charges,26.86% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,42.43,31.2,,,percent of total billed charges,31.2% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,24,,,percent of total billed charges,24% of total billed charges ,32.64,108.8,
OT ACT OF DAILY LIVING,9240005,CDM,430,RC,97535,HCPCS,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
OT ORTHOTICS TRNG/FITNG,9240006,CDM,430,RC,97760,HCPCS,Outpatient,,,51.5,25.75,,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,41.2,80,,,percent of total billed charges,80% of total billed charges ,12.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,25.96,50.4,,,percent of total billed charges,50.4% of total billed charges ,38.63,75,,,percent of total billed charges,75% of total billed charges ,12.61,24.48,,,percent of total billed charges,24.48% of total billed charges ,13.83,26.86,,,percent of total billed charges,26.86% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,16.07,31.2,,,percent of total billed charges,31.2% of total billed charges,41.2,80,,,percent of total billed charges,80% of total billed charges,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,24,,,percent of total billed charges,24% of total billed charges ,12.36,41.2,
OT COMM/WORK INTEGRAT,9240007,CDM,430,RC,97537,HCPCS,Outpatient,,,73,36.5,,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,58.4,
OT OT MASSAGE - 15 MIN,9240008,CDM,430,RC,97124,HCPCS,Outpatient,,,67,33.5,,18,26.86,,,percent of total billed charges,26.86% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,53.6,80,,,percent of total billed charges,80% of total billed charges ,16.24,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.77,50.4,,,percent of total billed charges,50.4% of total billed charges ,50.25,75,,,percent of total billed charges,75% of total billed charges ,16.4,24.48,,,percent of total billed charges,24.48% of total billed charges ,18,26.86,,,percent of total billed charges,26.86% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,20.9,31.2,,,percent of total billed charges,31.2% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,24,,,percent of total billed charges,24% of total billed charges ,16.08,53.6,
OT HOT PACK/COLD PACK,9240009,CDM,430,RC,97010,HCPCS,Outpatient,,,63,31.5,,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,50.4,80,,,percent of total billed charges,80% of total billed charges ,15.27,24.24,,,percent of total billed charges,24.24% of total billed charges ,31.75,50.4,,,percent of total billed charges,50.4% of total billed charges ,47.25,75,,,percent of total billed charges,75% of total billed charges ,15.42,24.48,,,percent of total billed charges,24.48% of total billed charges ,16.92,26.86,,,percent of total billed charges,26.86% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,19.66,31.2,,,percent of total billed charges,31.2% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,24,,,percent of total billed charges,24% of total billed charges ,15.12,50.4,
OT ROM MEASURE - HAND,9240010,CDM,430,RC,95852,HCPCS,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
OT MUSCLE TEST BODY&HAN,9240011,CDM,430,RC,97750,HCPCS,Outpatient,,,90.5,45.25,,24.31,26.86,,,percent of total billed charges,26.86% of total billed charges,67.88,75,,,percent of total billed charges,75% of total billed charges ,67.88,75,,,percent of total billed charges,75% of total billed charges ,21.72,24,,,percent of total billed charges,24% of total billed charges ,67.88,75,,,percent of total billed charges,75% of total billed charges ,67.88,75,,,percent of total billed charges,75% of total billed charges ,72.4,80,,,percent of total billed charges,80% of total billed charges ,21.94,24.24,,,percent of total billed charges,24.24% of total billed charges ,45.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,67.88,75,,,percent of total billed charges,75% of total billed charges ,22.15,24.48,,,percent of total billed charges,24.48% of total billed charges ,24.31,26.86,,,percent of total billed charges,26.86% of total billed charges,21.72,24,,,percent of total billed charges,24% of total billed charges ,28.24,31.2,,,percent of total billed charges,31.2% of total billed charges,72.4,80,,,percent of total billed charges,80% of total billed charges,21.72,24,,,percent of total billed charges,24% of total billed charges ,21.72,24,,,percent of total billed charges,24% of total billed charges ,21.72,72.4,
OT NEUROMUSCLE REEDUCAT,9240013,CDM,430,RC,97112,HCPCS,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
OT OCC THPY EVALUATION,9240014,CDM,430,RC,97166,HCPCS,Outpatient,,,356.5,178.25,,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,285.2,
OT OCC THPY RE-EVAL,9240015,CDM,430,RC,97168,HCPCS,Outpatient,,,178,89,,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,142.4,
OT PARRAFIN BATH,9240016,CDM,430,RC,97018,HCPCS,Outpatient,,,47.5,23.75,,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,38,80,,,percent of total billed charges,80% of total billed charges ,11.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,23.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,35.63,75,,,percent of total billed charges,75% of total billed charges ,11.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,12.76,26.86,,,percent of total billed charges,26.86% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,14.82,31.2,,,percent of total billed charges,31.2% of total billed charges,38,80,,,percent of total billed charges,80% of total billed charges,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,24,,,percent of total billed charges,24% of total billed charges ,11.4,38,
OT ORTH CHK/PROSTH CHK,9240017,CDM,430,RC,97763,HCPCS,Outpatient,,,104,52,,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,83.2,80,,,percent of total billed charges,80% of total billed charges ,25.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,25.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,32.45,31.2,,,percent of total billed charges,31.2% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,83.2,
OT COGNITIVE TRAINING,9240018,CDM,430,RC,97770,HCPCS,Outpatient,,,97,48.5,,26.05,26.86,,,percent of total billed charges,26.86% of total billed charges,72.75,75,,,percent of total billed charges,75% of total billed charges ,72.75,75,,,percent of total billed charges,75% of total billed charges ,23.28,24,,,percent of total billed charges,24% of total billed charges ,72.75,75,,,percent of total billed charges,75% of total billed charges ,72.75,75,,,percent of total billed charges,75% of total billed charges ,77.6,80,,,percent of total billed charges,80% of total billed charges ,23.51,24.24,,,percent of total billed charges,24.24% of total billed charges ,48.89,50.4,,,percent of total billed charges,50.4% of total billed charges ,72.75,75,,,percent of total billed charges,75% of total billed charges ,23.75,24.48,,,percent of total billed charges,24.48% of total billed charges ,26.05,26.86,,,percent of total billed charges,26.86% of total billed charges,23.28,24,,,percent of total billed charges,24% of total billed charges ,30.26,31.2,,,percent of total billed charges,31.2% of total billed charges,77.6,80,,,percent of total billed charges,80% of total billed charges,23.28,24,,,percent of total billed charges,24% of total billed charges ,23.28,24,,,percent of total billed charges,24% of total billed charges ,23.28,77.6,
OT THERAPEUTIC EXERCISE,9240019,CDM,430,RC,97110,HCPCS,Outpatient,,,73,36.5,,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,58.4,
OT THERAPEUTIC ACTIVITY,9240020,CDM,430,RC,97530,HCPCS,Outpatient,,,73,36.5,,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,58.4,80,,,percent of total billed charges,80% of total billed charges ,17.7,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.79,50.4,,,percent of total billed charges,50.4% of total billed charges ,54.75,75,,,percent of total billed charges,75% of total billed charges ,17.87,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.61,26.86,,,percent of total billed charges,26.86% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,22.78,31.2,,,percent of total billed charges,31.2% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,24,,,percent of total billed charges,24% of total billed charges ,17.52,58.4,
OT GROUP THERAPY,9240021,CDM,430,RC,97150,HCPCS,Outpatient,,,72,36,,19.34,26.86,,,percent of total billed charges,26.86% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,57.6,80,,,percent of total billed charges,80% of total billed charges ,17.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,36.29,50.4,,,percent of total billed charges,50.4% of total billed charges ,54,75,,,percent of total billed charges,75% of total billed charges ,17.63,24.48,,,percent of total billed charges,24.48% of total billed charges ,19.34,26.86,,,percent of total billed charges,26.86% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,22.46,31.2,,,percent of total billed charges,31.2% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,24,,,percent of total billed charges,24% of total billed charges ,17.28,57.6,
OT MANUAL THERAPY,9240023,CDM,430,RC,97140,HCPCS,Outpatient,,,95,47.5,,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,76,80,,,percent of total billed charges,80% of total billed charges ,23.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,47.88,50.4,,,percent of total billed charges,50.4% of total billed charges ,71.25,75,,,percent of total billed charges,75% of total billed charges ,23.26,24.48,,,percent of total billed charges,24.48% of total billed charges ,25.52,26.86,,,percent of total billed charges,26.86% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,29.64,31.2,,,percent of total billed charges,31.2% of total billed charges,76,80,,,percent of total billed charges,80% of total billed charges,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,24,,,percent of total billed charges,24% of total billed charges ,22.8,76,
OT FUNCTIONAL PERFORMANCE TESTING,9240024,CDM,430,RC,97750,HCPCS,Outpatient,,,114.5,57.25,,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,91.6,80,,,percent of total billed charges,80% of total billed charges ,27.75,24.24,,,percent of total billed charges,24.24% of total billed charges ,57.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,85.88,75,,,percent of total billed charges,75% of total billed charges ,28.03,24.48,,,percent of total billed charges,24.48% of total billed charges ,30.75,26.86,,,percent of total billed charges,26.86% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,35.72,31.2,,,percent of total billed charges,31.2% of total billed charges,91.6,80,,,percent of total billed charges,80% of total billed charges,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,24,,,percent of total billed charges,24% of total billed charges ,27.48,91.6,
OT OCC THPY EVAL: LOW COMPLEXITY,9240028,CDM,434,RC,97165,HCPCS,Outpatient,,,356.5,178.25,,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,285.2,
OT OCC THPY EVAL: MODERATE COMPLEXITY,9240029,CDM,434,RC,97166,HCPCS,Outpatient,,,356.5,178.25,,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,285.2,
OT OCC THPY EVAL: HIGH COMPLEXITY,9240030,CDM,434,RC,97167,HCPCS,Outpatient,,,356.5,178.25,,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,285.2,80,,,percent of total billed charges,80% of total billed charges ,86.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,179.68,50.4,,,percent of total billed charges,50.4% of total billed charges ,267.38,75,,,percent of total billed charges,75% of total billed charges ,87.27,24.48,,,percent of total billed charges,24.48% of total billed charges ,95.76,26.86,,,percent of total billed charges,26.86% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,111.23,31.2,,,percent of total billed charges,31.2% of total billed charges,285.2,80,,,percent of total billed charges,80% of total billed charges,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,24,,,percent of total billed charges,24% of total billed charges ,85.56,285.2,
OT OCC THPY EVAL: RE-EVAL,9240031,CDM,434,RC,97168,HCPCS,Outpatient,,,178,89,,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,142.4,80,,,percent of total billed charges,80% of total billed charges ,43.15,24.24,,,percent of total billed charges,24.24% of total billed charges ,89.71,50.4,,,percent of total billed charges,50.4% of total billed charges ,133.5,75,,,percent of total billed charges,75% of total billed charges ,43.57,24.48,,,percent of total billed charges,24.48% of total billed charges ,47.81,26.86,,,percent of total billed charges,26.86% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,55.54,31.2,,,percent of total billed charges,31.2% of total billed charges,142.4,80,,,percent of total billed charges,80% of total billed charges,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,24,,,percent of total billed charges,24% of total billed charges ,42.72,142.4,
PT RE EVALUATION,9240032,CDM,424,RC,97164,HCPCS,Outpatient,,,154.5,77.25,,41.5,26.86,,,percent of total billed charges,26.86% of total billed charges,115.88,75,,,percent of total billed charges,75% of total billed charges ,115.88,75,,,percent of total billed charges,75% of total billed charges ,37.08,24,,,percent of total billed charges,24% of total billed charges ,115.88,75,,,percent of total billed charges,75% of total billed charges ,115.88,75,,,percent of total billed charges,75% of total billed charges ,123.6,80,,,percent of total billed charges,80% of total billed charges ,37.45,24.24,,,percent of total billed charges,24.24% of total billed charges ,77.87,50.4,,,percent of total billed charges,50.4% of total billed charges ,115.88,75,,,percent of total billed charges,75% of total billed charges ,37.82,24.48,,,percent of total billed charges,24.48% of total billed charges ,41.5,26.86,,,percent of total billed charges,26.86% of total billed charges,37.08,24,,,percent of total billed charges,24% of total billed charges ,48.2,31.2,,,percent of total billed charges,31.2% of total billed charges,123.6,80,,,percent of total billed charges,80% of total billed charges,37.08,24,,,percent of total billed charges,24% of total billed charges ,37.08,24,,,percent of total billed charges,24% of total billed charges ,37.08,123.6,
ROM MEASURMENTS OT,9290169,CDM,420,RC,95851,HCPCS,Outpatient,,,66,33,,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,52.8,80,,,percent of total billed charges,80% of total billed charges ,16,24.24,,,percent of total billed charges,24.24% of total billed charges ,33.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,49.5,75,,,percent of total billed charges,75% of total billed charges ,16.16,24.48,,,percent of total billed charges,24.48% of total billed charges ,17.73,26.86,,,percent of total billed charges,26.86% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,20.59,31.2,,,percent of total billed charges,31.2% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,24,,,percent of total billed charges,24% of total billed charges ,15.84,52.8,
OT MUSCLE TESTING MANUAL MMT,9290170,CDM,420,RC,97750,HCPCS,Outpatient,,,78.5,39.25,,21.09,26.86,,,percent of total billed charges,26.86% of total billed charges,58.88,75,,,percent of total billed charges,75% of total billed charges ,58.88,75,,,percent of total billed charges,75% of total billed charges ,18.84,24,,,percent of total billed charges,24% of total billed charges ,58.88,75,,,percent of total billed charges,75% of total billed charges ,58.88,75,,,percent of total billed charges,75% of total billed charges ,62.8,80,,,percent of total billed charges,80% of total billed charges ,19.03,24.24,,,percent of total billed charges,24.24% of total billed charges ,39.56,50.4,,,percent of total billed charges,50.4% of total billed charges ,58.88,75,,,percent of total billed charges,75% of total billed charges ,19.22,24.48,,,percent of total billed charges,24.48% of total billed charges ,21.09,26.86,,,percent of total billed charges,26.86% of total billed charges,18.84,24,,,percent of total billed charges,24% of total billed charges ,24.49,31.2,,,percent of total billed charges,31.2% of total billed charges,62.8,80,,,percent of total billed charges,80% of total billed charges,18.84,24,,,percent of total billed charges,24% of total billed charges ,18.84,24,,,percent of total billed charges,24% of total billed charges ,18.84,62.8,
ST INIT SPEECH EVAL,9350000,CDM,440,RC,92521,HCPCS,Outpatient,,,310,155,,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,74.4,24,,,percent of total billed charges,24% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,248,80,,,percent of total billed charges,80% of total billed charges ,75.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,156.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,75.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,74.4,24,,,percent of total billed charges,24% of total billed charges ,96.72,31.2,,,percent of total billed charges,31.2% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,74.4,24,,,percent of total billed charges,24% of total billed charges ,74.4,24,,,percent of total billed charges,24% of total billed charges ,74.4,248,
ST SPEECH ASSESSMENT,9350001,CDM,444,RC,96105,HCPCS,Outpatient,,,247,123.5,,66.34,26.86,,,percent of total billed charges,26.86% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,59.28,24,,,percent of total billed charges,24% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,197.6,80,,,percent of total billed charges,80% of total billed charges ,59.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,124.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,60.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,66.34,26.86,,,percent of total billed charges,26.86% of total billed charges,59.28,24,,,percent of total billed charges,24% of total billed charges ,77.06,31.2,,,percent of total billed charges,31.2% of total billed charges,197.6,80,,,percent of total billed charges,80% of total billed charges,59.28,24,,,percent of total billed charges,24% of total billed charges ,59.28,24,,,percent of total billed charges,24% of total billed charges ,59.28,197.6,
ST TX SPEECH/AUD DISOR,9350002,CDM,440,RC,92507,HCPCS,Outpatient,,,290.5,145.25,,78.03,26.86,,,percent of total billed charges,26.86% of total billed charges,217.88,75,,,percent of total billed charges,75% of total billed charges ,217.88,75,,,percent of total billed charges,75% of total billed charges ,69.72,24,,,percent of total billed charges,24% of total billed charges ,217.88,75,,,percent of total billed charges,75% of total billed charges ,217.88,75,,,percent of total billed charges,75% of total billed charges ,232.4,80,,,percent of total billed charges,80% of total billed charges ,70.42,24.24,,,percent of total billed charges,24.24% of total billed charges ,146.41,50.4,,,percent of total billed charges,50.4% of total billed charges ,217.88,75,,,percent of total billed charges,75% of total billed charges ,71.11,24.48,,,percent of total billed charges,24.48% of total billed charges ,78.03,26.86,,,percent of total billed charges,26.86% of total billed charges,69.72,24,,,percent of total billed charges,24% of total billed charges ,90.64,31.2,,,percent of total billed charges,31.2% of total billed charges,232.4,80,,,percent of total billed charges,80% of total billed charges,69.72,24,,,percent of total billed charges,24% of total billed charges ,69.72,24,,,percent of total billed charges,24% of total billed charges ,69.72,232.4,
ST SPEECH GRP TREATMENT,9350003,CDM,440,RC,92508,HCPCS,Outpatient,,,82.5,41.25,,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,66,80,,,percent of total billed charges,80% of total billed charges ,20,24.24,,,percent of total billed charges,24.24% of total billed charges ,41.58,50.4,,,percent of total billed charges,50.4% of total billed charges ,61.88,75,,,percent of total billed charges,75% of total billed charges ,20.2,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.16,26.86,,,percent of total billed charges,26.86% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,25.74,31.2,,,percent of total billed charges,31.2% of total billed charges,66,80,,,percent of total billed charges,80% of total billed charges,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,24,,,percent of total billed charges,24% of total billed charges ,19.8,66,
ST HEARING SCREEN,9350004,CDM,470,RC,92552,HCPCS,Outpatient,,,104,52,,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,83.2,80,,,percent of total billed charges,80% of total billed charges ,25.21,24.24,,,percent of total billed charges,24.24% of total billed charges ,52.42,50.4,,,percent of total billed charges,50.4% of total billed charges ,78,75,,,percent of total billed charges,75% of total billed charges ,25.46,24.48,,,percent of total billed charges,24.48% of total billed charges ,27.93,26.86,,,percent of total billed charges,26.86% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,32.45,31.2,,,percent of total billed charges,31.2% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,24,,,percent of total billed charges,24% of total billed charges ,24.96,83.2,
ST DYSPHAGIA EVAL,9350005,CDM,440,RC,92610,HCPCS,Outpatient,,,247,123.5,,66.34,26.86,,,percent of total billed charges,26.86% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,59.28,24,,,percent of total billed charges,24% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,197.6,80,,,percent of total billed charges,80% of total billed charges ,59.87,24.24,,,percent of total billed charges,24.24% of total billed charges ,124.49,50.4,,,percent of total billed charges,50.4% of total billed charges ,185.25,75,,,percent of total billed charges,75% of total billed charges ,60.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,66.34,26.86,,,percent of total billed charges,26.86% of total billed charges,59.28,24,,,percent of total billed charges,24% of total billed charges ,77.06,31.2,,,percent of total billed charges,31.2% of total billed charges,197.6,80,,,percent of total billed charges,80% of total billed charges,59.28,24,,,percent of total billed charges,24% of total billed charges ,59.28,24,,,percent of total billed charges,24% of total billed charges ,59.28,197.6,
ST DYSPHAGIA TREATMENT,9350006,CDM,440,RC,92526,HCPCS,Outpatient,,,165,82.5,,44.32,26.86,,,percent of total billed charges,26.86% of total billed charges,123.75,75,,,percent of total billed charges,75% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,39.6,24,,,percent of total billed charges,24% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,132,80,,,percent of total billed charges,80% of total billed charges ,40,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,40.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,44.32,26.86,,,percent of total billed charges,26.86% of total billed charges,39.6,24,,,percent of total billed charges,24% of total billed charges ,51.48,31.2,,,percent of total billed charges,31.2% of total billed charges,132,80,,,percent of total billed charges,80% of total billed charges,39.6,24,,,percent of total billed charges,24% of total billed charges ,39.6,24,,,percent of total billed charges,24% of total billed charges ,39.6,132,
ST APHASIA ASSESSMENT,9350007,CDM,444,RC,96105,HCPCS,Outpatient,,,165,82.5,,44.32,26.86,,,percent of total billed charges,26.86% of total billed charges,123.75,75,,,percent of total billed charges,75% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,39.6,24,,,percent of total billed charges,24% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,132,80,,,percent of total billed charges,80% of total billed charges ,40,24.24,,,percent of total billed charges,24.24% of total billed charges ,83.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,123.75,75,,,percent of total billed charges,75% of total billed charges ,40.39,24.48,,,percent of total billed charges,24.48% of total billed charges ,44.32,26.86,,,percent of total billed charges,26.86% of total billed charges,39.6,24,,,percent of total billed charges,24% of total billed charges ,51.48,31.2,,,percent of total billed charges,31.2% of total billed charges,132,80,,,percent of total billed charges,80% of total billed charges,39.6,24,,,percent of total billed charges,24% of total billed charges ,39.6,24,,,percent of total billed charges,24% of total billed charges ,39.6,132,
ST THINKING ASSESSMENT,9350008,CDM,440,RC,,,Outpatient,,,206,103,,55.33,26.86,,,percent of total billed charges,26.86% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,164.8,80,,,percent of total billed charges,80% of total billed charges ,49.93,24.24,,,percent of total billed charges,24.24% of total billed charges ,103.82,50.4,,,percent of total billed charges,50.4% of total billed charges ,154.5,75,,,percent of total billed charges,75% of total billed charges ,50.43,24.48,,,percent of total billed charges,24.48% of total billed charges ,55.33,26.86,,,percent of total billed charges,26.86% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,64.27,31.2,,,percent of total billed charges,31.2% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,24,,,percent of total billed charges,24% of total billed charges ,49.44,164.8,
ST EVAL SPEECH SOUND LANG COMPREH,9350009,CDM,440,RC,92523,HCPCS,Outpatient,,,439,219.5,,117.92,26.86,,,percent of total billed charges,26.86% of total billed charges,329.25,75,,,percent of total billed charges,75% of total billed charges ,329.25,75,,,percent of total billed charges,75% of total billed charges ,105.36,24,,,percent of total billed charges,24% of total billed charges ,329.25,75,,,percent of total billed charges,75% of total billed charges ,329.25,75,,,percent of total billed charges,75% of total billed charges ,351.2,80,,,percent of total billed charges,80% of total billed charges ,106.41,24.24,,,percent of total billed charges,24.24% of total billed charges ,221.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,329.25,75,,,percent of total billed charges,75% of total billed charges ,107.47,24.48,,,percent of total billed charges,24.48% of total billed charges ,117.92,26.86,,,percent of total billed charges,26.86% of total billed charges,105.36,24,,,percent of total billed charges,24% of total billed charges ,136.97,31.2,,,percent of total billed charges,31.2% of total billed charges,351.2,80,,,percent of total billed charges,80% of total billed charges,105.36,24,,,percent of total billed charges,24% of total billed charges ,105.36,24,,,percent of total billed charges,24% of total billed charges ,105.36,351.2,
ST COGNITIVE SKILLS DEVELOPMENT,9350010,CDM,440,RC,97129,HCPCS,Outpatient,,,117.5,58.75,,31.56,26.86,,,percent of total billed charges,26.86% of total billed charges,88.13,75,,,percent of total billed charges,75% of total billed charges ,88.13,75,,,percent of total billed charges,75% of total billed charges ,28.2,24,,,percent of total billed charges,24% of total billed charges ,88.13,75,,,percent of total billed charges,75% of total billed charges ,88.13,75,,,percent of total billed charges,75% of total billed charges ,94,80,,,percent of total billed charges,80% of total billed charges ,28.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,59.22,50.4,,,percent of total billed charges,50.4% of total billed charges ,88.13,75,,,percent of total billed charges,75% of total billed charges ,28.76,24.48,,,percent of total billed charges,24.48% of total billed charges ,31.56,26.86,,,percent of total billed charges,26.86% of total billed charges,28.2,24,,,percent of total billed charges,24% of total billed charges ,36.66,31.2,,,percent of total billed charges,31.2% of total billed charges,94,80,,,percent of total billed charges,80% of total billed charges,28.2,24,,,percent of total billed charges,24% of total billed charges ,28.2,24,,,percent of total billed charges,24% of total billed charges ,28.2,94,
ST SPEECH/HEARING EVAL (DELETED),9350020,CDM,440,RC,92521,HCPCS,Outpatient,,,310,155,,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,74.4,24,,,percent of total billed charges,24% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,248,80,,,percent of total billed charges,80% of total billed charges ,75.14,24.24,,,percent of total billed charges,24.24% of total billed charges ,156.24,50.4,,,percent of total billed charges,50.4% of total billed charges ,232.5,75,,,percent of total billed charges,75% of total billed charges ,75.89,24.48,,,percent of total billed charges,24.48% of total billed charges ,83.27,26.86,,,percent of total billed charges,26.86% of total billed charges,74.4,24,,,percent of total billed charges,24% of total billed charges ,96.72,31.2,,,percent of total billed charges,31.2% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,74.4,24,,,percent of total billed charges,24% of total billed charges ,74.4,24,,,percent of total billed charges,24% of total billed charges ,74.4,248,
ST MOTION SWALLOW/FLUOR,9350021,CDM,444,RC,92611,HCPCS,Outpatient,,,415,207.5,,111.47,26.86,,,percent of total billed charges,26.86% of total billed charges,311.25,75,,,percent of total billed charges,75% of total billed charges ,311.25,75,,,percent of total billed charges,75% of total billed charges ,99.6,24,,,percent of total billed charges,24% of total billed charges ,311.25,75,,,percent of total billed charges,75% of total billed charges ,311.25,75,,,percent of total billed charges,75% of total billed charges ,332,80,,,percent of total billed charges,80% of total billed charges ,100.6,24.24,,,percent of total billed charges,24.24% of total billed charges ,209.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,311.25,75,,,percent of total billed charges,75% of total billed charges ,101.59,24.48,,,percent of total billed charges,24.48% of total billed charges ,111.47,26.86,,,percent of total billed charges,26.86% of total billed charges,99.6,24,,,percent of total billed charges,24% of total billed charges ,129.48,31.2,,,percent of total billed charges,31.2% of total billed charges,332,80,,,percent of total billed charges,80% of total billed charges,99.6,24,,,percent of total billed charges,24% of total billed charges ,99.6,24,,,percent of total billed charges,24% of total billed charges ,99.6,332,
VAPORTHERM GAS VENT FLOW FILTER,170997,CDM,210,RC,,,Inpatient,,,71.5,35.75,,,,,,Other,Not Separately reimbursable,4274,100,,,per diem,paid based on per day rate,4098,100,,,per diem,paid based on per day rate,3548.49,100,,,per diem,paid based on per day rate,2906,100,,,per diem,paid based on per day rate,4314,100,,,per diem,paid based on per day rate,57.2,80,,,percent of total billed charges,80% of total billed charges ,50.05,70,,,percent of total billed charges,70% of total billed charges ,2268,100,,,per diem,paid based on per day rate,1500,100,,,per diem,paid based on per day rate,3619.45,102,,,per diem,paid based on per day rate,,,,,Other,Not Separately reimbursable,3548.49,100,,,per diem,paid based on per day rate,4613.03,130,,,per diem,paid based on per day rate,60.78,85,,,percent of total billed charges,85% of total billed charges,3548.49,100,,,per diem,paid based on per day rate,3548.49,100,,,per diem,paid based on per day rate,50.05,4613.03,
AMPICILLIN 2GM INJ,7003568,CDM,121,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3832,100,,,per diem,paid based on per day rate,3675,100,,,per diem,paid based on per day rate,3548.49,100,,,per diem,paid based on per day rate,2606,100,,,per diem,paid based on per day rate,3868,100,,,per diem,paid based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1685,100,,,per diem,paid based on per day rate,1500,100,,,per diem,paid based on per day rate,3619.45,102,,,per diem,paid based on per day rate,,,,,Other,Not Separately reimbursable,3548.49,100,,,per diem,paid based on per day rate,4613.03,130,,,per diem,paid based on per day rate,,,,,Other,Not Separately reimbursable,3548.49,100,,,per diem,paid based on per day rate,3548.49,100,,,per diem,paid based on per day rate,1500,4613.03,
ZZZNF-Accupril Tablet 20MG,7004889,CDM,112,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3832,100,,,per diem,paid based on per day rate,3675,100,,,per diem,paid based on per day rate,3548.49,100,,,per diem,paid based on per day rate,2606,100,,,per diem,paid based on per day rate,3868,100,,,per diem,paid based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1685,100,,,per diem,paid based on per day rate,1500,100,,,per diem,paid based on per day rate,3619.45,102,,,per diem,paid based on per day rate,,,,,Other,Not Separately reimbursable,3548.49,100,,,per diem,paid based on per day rate,4613.03,130,,,per diem,paid based on per day rate,,,,,Other,Not Separately reimbursable,3548.49,100,,,per diem,paid based on per day rate,3548.49,100,,,per diem,paid based on per day rate,1500,4613.03,
LOW SEVERITY FOR SAME DAY ADMISSION/DISC,200001,CDM,987,RC,99234,HCPCS,Outpatient,,,276,138,,74.13,26.86,,,percent of total billed charges,26.86% of total billed charges,207,75,,,percent of total billed charges,75% of total billed charges ,207,75,,,percent of total billed charges,75% of total billed charges ,9.24,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,207,75,,,percent of total billed charges,75% of total billed charges ,207,75,,,percent of total billed charges,75% of total billed charges ,220.8,80,,,percent of total billed charges,80% of total billed charges ,9.33,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,139.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,207,75,,,percent of total billed charges,75% of total billed charges ,9.42,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,74.13,26.86,,,percent of total billed charges,26.86% of total billed charges,9.24,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.81,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,220.8,80,,,percent of total billed charges,80% of total billed charges,9.24,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.24,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.24,220.8,
I&D SIMPLE OR SINGLE,1410060,CDM,987,RC,10060,HCPCS,Outpatient,,,277,138.5,,74.4,26.86,,,percent of total billed charges,26.86% of total billed charges,207.75,75,,,percent of total billed charges,75% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,8.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,207.75,75,,,percent of total billed charges,75% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,221.6,80,,,percent of total billed charges,80% of total billed charges ,8.15,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,139.61,50.4,,,percent of total billed charges,50.4% of total billed charges ,207.75,75,,,percent of total billed charges,75% of total billed charges ,8.23,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,74.4,26.86,,,percent of total billed charges,26.86% of total billed charges,8.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.06,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,221.6,80,,,percent of total billed charges,80% of total billed charges,8.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.07,221.6,
I&D UPPER ARM/ELBOW BURSA,1410070,CDM,987,RC,23931,HCPCS,Outpatient,,,319.5,159.75,,85.82,26.86,,,percent of total billed charges,26.86% of total billed charges,239.63,75,,,percent of total billed charges,75% of total billed charges ,239.63,75,,,percent of total billed charges,75% of total billed charges ,17.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,239.63,75,,,percent of total billed charges,75% of total billed charges ,239.63,75,,,percent of total billed charges,75% of total billed charges ,255.6,80,,,percent of total billed charges,80% of total billed charges ,18.15,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,161.03,50.4,,,percent of total billed charges,50.4% of total billed charges ,239.63,75,,,percent of total billed charges,75% of total billed charges ,18.33,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,85.82,26.86,,,percent of total billed charges,26.86% of total billed charges,17.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,26.86,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,255.6,80,,,percent of total billed charges,80% of total billed charges,17.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.97,255.6,
INTUBATION ENDOTRACHEAL ER PROCEDURE,1431500,CDM,987,RC,31500,HCPCS,Outpatient,,,544,272,,146.12,26.86,,,percent of total billed charges,26.86% of total billed charges,408,75,,,percent of total billed charges,75% of total billed charges ,408,75,,,percent of total billed charges,75% of total billed charges ,20.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,408,75,,,percent of total billed charges,75% of total billed charges ,408,75,,,percent of total billed charges,75% of total billed charges ,435.2,80,,,percent of total billed charges,80% of total billed charges ,20.4,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,274.18,50.4,,,percent of total billed charges,50.4% of total billed charges ,408,75,,,percent of total billed charges,75% of total billed charges ,20.6,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,146.12,26.86,,,percent of total billed charges,26.86% of total billed charges,20.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.2,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,435.2,80,,,percent of total billed charges,80% of total billed charges,20.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.2,435.2,
CENTRAL LINE > 5 YRS,1436556,CDM,987,RC,36556,HCPCS,Outpatient,,,699.5,349.75,,187.89,26.86,,,percent of total billed charges,26.86% of total billed charges,524.63,75,,,percent of total billed charges,75% of total billed charges ,524.63,75,,,percent of total billed charges,75% of total billed charges ,11.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,524.63,75,,,percent of total billed charges,75% of total billed charges ,524.63,75,,,percent of total billed charges,75% of total billed charges ,559.6,80,,,percent of total billed charges,80% of total billed charges ,11.18,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,352.55,50.4,,,percent of total billed charges,50.4% of total billed charges ,524.63,75,,,percent of total billed charges,75% of total billed charges ,11.29,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,187.89,26.86,,,percent of total billed charges,26.86% of total billed charges,11.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,16.54,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,559.6,80,,,percent of total billed charges,80% of total billed charges,11.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.06,559.6,
ECG ROUTINE INTERPRETATION AND REPORT ON,1493010,CDM,985,RC,93010,HCPCS,Outpatient,,,37,18.5,,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,0.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,27.75,75,,,percent of total billed charges,75% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,29.6,80,,,percent of total billed charges,80% of total billed charges ,0.62,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,18.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,27.75,75,,,percent of total billed charges,75% of total billed charges ,0.63,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,9.94,26.86,,,percent of total billed charges,26.86% of total billed charges,0.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,0.92,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,29.6,80,,,percent of total billed charges,80% of total billed charges,0.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,0.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,0.61,29.6,
NEW PATIENT LEVEL 3 (30 MINS),1499203,CDM,987,RC,99203,HCPCS,Outpatient,,,246,123,,66.08,26.86,,,percent of total billed charges,26.86% of total billed charges,184.5,75,,,percent of total billed charges,75% of total billed charges ,184.5,75,,,percent of total billed charges,75% of total billed charges ,8.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,184.5,75,,,percent of total billed charges,75% of total billed charges ,184.5,75,,,percent of total billed charges,75% of total billed charges ,196.8,80,,,percent of total billed charges,80% of total billed charges ,8.49,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,123.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,184.5,75,,,percent of total billed charges,75% of total billed charges ,8.57,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,66.08,26.86,,,percent of total billed charges,26.86% of total billed charges,8.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.57,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,196.8,80,,,percent of total billed charges,80% of total billed charges,8.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.4,196.8,
NEW PATIENT LEVEL 4 (45 MINS),1499204,CDM,987,RC,99204,HCPCS,Outpatient,,,384,192,,103.14,26.86,,,percent of total billed charges,26.86% of total billed charges,288,75,,,percent of total billed charges,75% of total billed charges ,288,75,,,percent of total billed charges,75% of total billed charges ,12.92,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,288,75,,,percent of total billed charges,75% of total billed charges ,288,75,,,percent of total billed charges,75% of total billed charges ,307.2,80,,,percent of total billed charges,80% of total billed charges ,13.05,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,193.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,288,75,,,percent of total billed charges,75% of total billed charges ,13.18,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,103.14,26.86,,,percent of total billed charges,26.86% of total billed charges,12.92,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.31,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,307.2,80,,,percent of total billed charges,80% of total billed charges,12.92,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.92,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.92,307.2,
ESTABLISHED PT LEVEL 4 (25 MINS),1499214,CDM,987,RC,99214,HCPCS,Outpatient,,,384,192,,103.14,26.86,,,percent of total billed charges,26.86% of total billed charges,288,75,,,percent of total billed charges,75% of total billed charges ,288,75,,,percent of total billed charges,75% of total billed charges ,8.11,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,288,75,,,percent of total billed charges,75% of total billed charges ,288,75,,,percent of total billed charges,75% of total billed charges ,307.2,80,,,percent of total billed charges,80% of total billed charges ,8.19,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,193.54,50.4,,,percent of total billed charges,50.4% of total billed charges ,288,75,,,percent of total billed charges,75% of total billed charges ,8.27,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,103.14,26.86,,,percent of total billed charges,26.86% of total billed charges,8.11,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.12,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,307.2,80,,,percent of total billed charges,80% of total billed charges,8.11,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.11,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.11,307.2,
OBSERVATION CARE DISCHARGE,1499217,CDM,987,RC,99217,HCPCS,Outpatient,,,148.5,74.25,,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,35.64,24,,,percent of total billed charges,24% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,118.8,80,,,percent of total billed charges,80% of total billed charges ,36,24.24,,,percent of total billed charges,24.24% of total billed charges ,74.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,36.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,35.64,24,,,percent of total billed charges,24% of total billed charges ,46.33,31.2,,,percent of total billed charges,31.2% of total billed charges ,118.8,80,,,percent of total billed charges,80% of total billed charges,35.64,24,,,percent of total billed charges,24% of total billed charges ,35.64,24,,,percent of total billed charges,24% of total billed charges ,35.64,118.8,
INITIAL OBSERVATION CARE LOW SEVERITY,1499218,CDM,987,RC,99218,HCPCS,Outpatient,,,202,101,,54.26,26.86,,,percent of total billed charges,26.86% of total billed charges,151.5,75,,,percent of total billed charges,75% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,48.48,24,,,percent of total billed charges,24% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,161.6,80,,,percent of total billed charges,80% of total billed charges ,48.96,24.24,,,percent of total billed charges,24.24% of total billed charges ,101.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,151.5,75,,,percent of total billed charges,75% of total billed charges ,49.45,24.48,,,percent of total billed charges,24.48% of total billed charges ,54.26,26.86,,,percent of total billed charges,26.86% of total billed charges,48.48,24,,,percent of total billed charges,24% of total billed charges ,63.02,31.2,,,percent of total billed charges,31.2% of total billed charges ,161.6,80,,,percent of total billed charges,80% of total billed charges,48.48,24,,,percent of total billed charges,24% of total billed charges ,48.48,24,,,percent of total billed charges,24% of total billed charges ,48.48,161.6,
INITIAL OBSERVATION CARE MODERATE SEVERI,1499219,CDM,987,RC,99219,HCPCS,Outpatient,,,276,138,,74.13,26.86,,,percent of total billed charges,26.86% of total billed charges,207,75,,,percent of total billed charges,75% of total billed charges ,207,75,,,percent of total billed charges,75% of total billed charges ,66.24,24,,,percent of total billed charges,24% of total billed charges ,207,75,,,percent of total billed charges,75% of total billed charges ,207,75,,,percent of total billed charges,75% of total billed charges ,220.8,80,,,percent of total billed charges,80% of total billed charges ,66.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,207,75,,,percent of total billed charges,75% of total billed charges ,67.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,74.13,26.86,,,percent of total billed charges,26.86% of total billed charges,66.24,24,,,percent of total billed charges,24% of total billed charges ,86.11,31.2,,,percent of total billed charges,31.2% of total billed charges ,220.8,80,,,percent of total billed charges,80% of total billed charges,66.24,24,,,percent of total billed charges,24% of total billed charges ,66.24,24,,,percent of total billed charges,24% of total billed charges ,66.24,220.8,
INITIAL OBSERVATION CARE PER DAY,1499220,CDM,987,RC,99220,HCPCS,Outpatient,,,382,191,,102.61,26.86,,,percent of total billed charges,26.86% of total billed charges,286.5,75,,,percent of total billed charges,75% of total billed charges ,286.5,75,,,percent of total billed charges,75% of total billed charges ,91.68,24,,,percent of total billed charges,24% of total billed charges ,286.5,75,,,percent of total billed charges,75% of total billed charges ,286.5,75,,,percent of total billed charges,75% of total billed charges ,305.6,80,,,percent of total billed charges,80% of total billed charges ,92.6,24.24,,,percent of total billed charges,24.24% of total billed charges ,192.53,50.4,,,percent of total billed charges,50.4% of total billed charges ,286.5,75,,,percent of total billed charges,75% of total billed charges ,93.51,24.48,,,percent of total billed charges,24.48% of total billed charges ,102.61,26.86,,,percent of total billed charges,26.86% of total billed charges,91.68,24,,,percent of total billed charges,24% of total billed charges ,119.18,31.2,,,percent of total billed charges,31.2% of total billed charges ,305.6,80,,,percent of total billed charges,80% of total billed charges,91.68,24,,,percent of total billed charges,24% of total billed charges ,91.68,24,,,percent of total billed charges,24% of total billed charges ,91.68,305.6,
INITIAL HOSPITAL CARE PER DAY 30 MINS,1499221,CDM,987,RC,99221,HCPCS,Outpatient,,,212,106,,56.94,26.86,,,percent of total billed charges,26.86% of total billed charges,159,75,,,percent of total billed charges,75% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,9.17,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,159,75,,,percent of total billed charges,75% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,169.6,80,,,percent of total billed charges,80% of total billed charges ,9.26,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,106.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,9.35,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,56.94,26.86,,,percent of total billed charges,26.86% of total billed charges,9.17,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.71,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,169.6,80,,,percent of total billed charges,80% of total billed charges,9.17,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.17,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.17,169.6,
INITIAL HOSPITAL CARE 50 MINS,1499222,CDM,987,RC,99222,HCPCS,Outpatient,,,286.5,143.25,,76.95,26.86,,,percent of total billed charges,26.86% of total billed charges,214.88,75,,,percent of total billed charges,75% of total billed charges ,214.88,75,,,percent of total billed charges,75% of total billed charges ,12.45,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,214.88,75,,,percent of total billed charges,75% of total billed charges ,214.88,75,,,percent of total billed charges,75% of total billed charges ,229.2,80,,,percent of total billed charges,80% of total billed charges ,12.58,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,144.4,50.4,,,percent of total billed charges,50.4% of total billed charges ,214.88,75,,,percent of total billed charges,75% of total billed charges ,12.7,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,76.95,26.86,,,percent of total billed charges,26.86% of total billed charges,12.45,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,18.62,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,229.2,80,,,percent of total billed charges,80% of total billed charges,12.45,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.45,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.45,229.2,
INITIAL HOSPITAL CARE HIGH COMPLEXITY,1499223,CDM,987,RC,99223,HCPCS,Outpatient,,,424.5,212.25,,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,14.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,318.38,75,,,percent of total billed charges,75% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,339.6,80,,,percent of total billed charges,80% of total billed charges ,14.98,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,213.95,50.4,,,percent of total billed charges,50.4% of total billed charges ,318.38,75,,,percent of total billed charges,75% of total billed charges ,15.13,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,114.02,26.86,,,percent of total billed charges,26.86% of total billed charges,14.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,22.18,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,339.6,80,,,percent of total billed charges,80% of total billed charges,14.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.83,339.6,
SUBSEQUENT OBSERVATION CARE 15 MINS,1499224,CDM,987,RC,99224,HCPCS,Outpatient,,,84.5,42.25,,22.7,26.86,,,percent of total billed charges,26.86% of total billed charges,63.38,75,,,percent of total billed charges,75% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,20.28,24,,,percent of total billed charges,24% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,67.6,80,,,percent of total billed charges,80% of total billed charges ,20.48,24.24,,,percent of total billed charges,24.24% of total billed charges ,42.59,50.4,,,percent of total billed charges,50.4% of total billed charges ,63.38,75,,,percent of total billed charges,75% of total billed charges ,20.69,24.48,,,percent of total billed charges,24.48% of total billed charges ,22.7,26.86,,,percent of total billed charges,26.86% of total billed charges,20.28,24,,,percent of total billed charges,24% of total billed charges ,26.36,31.2,,,percent of total billed charges,31.2% of total billed charges ,67.6,80,,,percent of total billed charges,80% of total billed charges,20.28,24,,,percent of total billed charges,24% of total billed charges ,20.28,24,,,percent of total billed charges,24% of total billed charges ,20.28,67.6,
SUBSEQUENT OBSERVATION CARE 25 MINS,1499225,CDM,987,RC,99225,HCPCS,Outpatient,,,148.5,74.25,,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,35.64,24,,,percent of total billed charges,24% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,118.8,80,,,percent of total billed charges,80% of total billed charges ,36,24.24,,,percent of total billed charges,24.24% of total billed charges ,74.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,36.35,24.48,,,percent of total billed charges,24.48% of total billed charges ,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,35.64,24,,,percent of total billed charges,24% of total billed charges ,46.33,31.2,,,percent of total billed charges,31.2% of total billed charges ,118.8,80,,,percent of total billed charges,80% of total billed charges,35.64,24,,,percent of total billed charges,24% of total billed charges ,35.64,24,,,percent of total billed charges,24% of total billed charges ,35.64,118.8,
SUBSEQUENT HOSPITAL CARE 15 MINS,1499231,CDM,987,RC,99231,HCPCS,Outpatient,,,108,54,,29.01,26.86,,,percent of total billed charges,26.86% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,4.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,81,75,,,percent of total billed charges,75% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,86.4,80,,,percent of total billed charges,80% of total billed charges ,4.87,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,54.43,50.4,,,percent of total billed charges,50.4% of total billed charges ,81,75,,,percent of total billed charges,75% of total billed charges ,4.92,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,29.01,26.86,,,percent of total billed charges,26.86% of total billed charges,4.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.21,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,86.4,80,,,percent of total billed charges,80% of total billed charges,4.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.83,86.4,
SUBSEQUENT HOSPITAL CARE PER DAY 25 MINS,1499232,CDM,987,RC,99232,HCPCS,Outpatient,,,148.5,74.25,,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,6.81,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,111.38,75,,,percent of total billed charges,75% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,118.8,80,,,percent of total billed charges,80% of total billed charges ,6.88,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,74.84,50.4,,,percent of total billed charges,50.4% of total billed charges ,111.38,75,,,percent of total billed charges,75% of total billed charges ,6.95,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,39.89,26.86,,,percent of total billed charges,26.86% of total billed charges,6.81,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.19,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,118.8,80,,,percent of total billed charges,80% of total billed charges,6.81,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.81,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.81,118.8,
SUBSEQUENT HOSPITAL VISIT - 35 MINUTES,1499233,CDM,987,RC,99233,HCPCS,Outpatient,,,275,137.5,,73.87,26.86,,,percent of total billed charges,26.86% of total billed charges,206.25,75,,,percent of total billed charges,75% of total billed charges ,206.25,75,,,percent of total billed charges,75% of total billed charges ,10.23,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,206.25,75,,,percent of total billed charges,75% of total billed charges ,206.25,75,,,percent of total billed charges,75% of total billed charges ,220,80,,,percent of total billed charges,80% of total billed charges ,10.33,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,138.6,50.4,,,percent of total billed charges,50.4% of total billed charges ,206.25,75,,,percent of total billed charges,75% of total billed charges ,10.44,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,73.87,26.86,,,percent of total billed charges,26.86% of total billed charges,10.23,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.29,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,220,80,,,percent of total billed charges,80% of total billed charges,10.23,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.23,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.23,220,
OBSERVATION OR IP STAY INCLUDING ADMIT A,1499234,CDM,987,RC,99234,HCPCS,Outpatient,,,276,138,,74.13,26.86,,,percent of total billed charges,26.86% of total billed charges,207,75,,,percent of total billed charges,75% of total billed charges ,207,75,,,percent of total billed charges,75% of total billed charges ,9.24,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,207,75,,,percent of total billed charges,75% of total billed charges ,207,75,,,percent of total billed charges,75% of total billed charges ,220.8,80,,,percent of total billed charges,80% of total billed charges ,9.33,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,139.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,207,75,,,percent of total billed charges,75% of total billed charges ,9.42,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,74.13,26.86,,,percent of total billed charges,26.86% of total billed charges,9.24,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.81,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,220.8,80,,,percent of total billed charges,80% of total billed charges,9.24,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.24,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.24,220.8,
OBSERVATION OR INPATIENT HOSPITAL CARE,1499235,CDM,987,RC,99235,HCPCS,Outpatient,,,360.5,180.25,,96.83,26.86,,,percent of total billed charges,26.86% of total billed charges,270.38,75,,,percent of total billed charges,75% of total billed charges ,270.38,75,,,percent of total billed charges,75% of total billed charges ,13.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,270.38,75,,,percent of total billed charges,75% of total billed charges ,270.38,75,,,percent of total billed charges,75% of total billed charges ,288.4,80,,,percent of total billed charges,80% of total billed charges ,13.81,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,181.69,50.4,,,percent of total billed charges,50.4% of total billed charges ,270.38,75,,,percent of total billed charges,75% of total billed charges ,13.95,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,96.83,26.86,,,percent of total billed charges,26.86% of total billed charges,13.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.45,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,288.4,80,,,percent of total billed charges,80% of total billed charges,13.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.68,288.4,
OBSERVATION OR INPATIENT HOSPITAL CARE,1499236,CDM,987,RC,99236,HCPCS,Outpatient,,,464.5,232.25,,124.76,26.86,,,percent of total billed charges,26.86% of total billed charges,348.38,75,,,percent of total billed charges,75% of total billed charges ,348.38,75,,,percent of total billed charges,75% of total billed charges ,18.11,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,348.38,75,,,percent of total billed charges,75% of total billed charges ,348.38,75,,,percent of total billed charges,75% of total billed charges ,371.6,80,,,percent of total billed charges,80% of total billed charges ,18.29,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,234.11,50.4,,,percent of total billed charges,50.4% of total billed charges ,348.38,75,,,percent of total billed charges,75% of total billed charges ,18.47,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,124.76,26.86,,,percent of total billed charges,26.86% of total billed charges,18.11,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,27.07,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,371.6,80,,,percent of total billed charges,80% of total billed charges,18.11,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,18.11,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,18.11,371.6,
HOSPITAL DISCHARGE DAY MNGMT <30 MINS,1499238,CDM,987,RC,99238,HCPCS,Outpatient,,,152.5,76.25,,40.96,26.86,,,percent of total billed charges,26.86% of total billed charges,114.38,75,,,percent of total billed charges,75% of total billed charges ,114.38,75,,,percent of total billed charges,75% of total billed charges ,6.51,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,114.38,75,,,percent of total billed charges,75% of total billed charges ,114.38,75,,,percent of total billed charges,75% of total billed charges ,122,80,,,percent of total billed charges,80% of total billed charges ,6.58,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,76.86,50.4,,,percent of total billed charges,50.4% of total billed charges ,114.38,75,,,percent of total billed charges,75% of total billed charges ,6.64,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,40.96,26.86,,,percent of total billed charges,26.86% of total billed charges,6.51,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.73,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,122,80,,,percent of total billed charges,80% of total billed charges,6.51,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.51,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.51,122,
HOSPITAL DISCHARGE > 30 MINS,1499239,CDM,987,RC,99239,HCPCS,Outpatient,,,222.5,111.25,,59.76,26.86,,,percent of total billed charges,26.86% of total billed charges,166.88,75,,,percent of total billed charges,75% of total billed charges ,166.88,75,,,percent of total billed charges,75% of total billed charges ,8.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,166.88,75,,,percent of total billed charges,75% of total billed charges ,166.88,75,,,percent of total billed charges,75% of total billed charges ,178,80,,,percent of total billed charges,80% of total billed charges ,9.08,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,112.14,50.4,,,percent of total billed charges,50.4% of total billed charges ,166.88,75,,,percent of total billed charges,75% of total billed charges ,9.17,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,59.76,26.86,,,percent of total billed charges,26.86% of total billed charges,8.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.44,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,178,80,,,percent of total billed charges,80% of total billed charges,8.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.99,178,
OP CONSULT EXPANDED PROBLEM FOCUSED,1499242,CDM,987,RC,99242,HCPCS,Outpatient,,,244,122,,65.54,26.86,,,percent of total billed charges,26.86% of total billed charges,183,75,,,percent of total billed charges,75% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,4.27,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,183,75,,,percent of total billed charges,75% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,195.2,80,,,percent of total billed charges,80% of total billed charges ,4.31,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,122.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,183,75,,,percent of total billed charges,75% of total billed charges ,4.36,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,65.54,26.86,,,percent of total billed charges,26.86% of total billed charges,4.27,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.38,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,195.2,80,,,percent of total billed charges,80% of total billed charges,4.27,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.27,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.27,195.2,
OP CONSULT DETAILED,1499243,CDM,987,RC,99243,HCPCS,Outpatient,,,311,155.5,,83.53,26.86,,,percent of total billed charges,26.86% of total billed charges,233.25,75,,,percent of total billed charges,75% of total billed charges ,233.25,75,,,percent of total billed charges,75% of total billed charges ,6.72,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,233.25,75,,,percent of total billed charges,75% of total billed charges ,233.25,75,,,percent of total billed charges,75% of total billed charges ,248.8,80,,,percent of total billed charges,80% of total billed charges ,6.79,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,156.74,50.4,,,percent of total billed charges,50.4% of total billed charges ,233.25,75,,,percent of total billed charges,75% of total billed charges ,6.86,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,83.53,26.86,,,percent of total billed charges,26.86% of total billed charges,6.72,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.05,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,248.8,80,,,percent of total billed charges,80% of total billed charges,6.72,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.72,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.72,248.8,
INPATIENT CONSULT PROBLEM FOCUSED,1499251,CDM,987,RC,99251,HCPCS,Outpatient,,,276,138,,74.13,26.86,,,percent of total billed charges,26.86% of total billed charges,207,75,,,percent of total billed charges,75% of total billed charges ,207,75,,,percent of total billed charges,75% of total billed charges ,66.24,24,,,percent of total billed charges,24% of total billed charges ,207,75,,,percent of total billed charges,75% of total billed charges ,207,75,,,percent of total billed charges,75% of total billed charges ,220.8,80,,,percent of total billed charges,80% of total billed charges ,66.9,24.24,,,percent of total billed charges,24.24% of total billed charges ,139.1,50.4,,,percent of total billed charges,50.4% of total billed charges ,207,75,,,percent of total billed charges,75% of total billed charges ,67.56,24.48,,,percent of total billed charges,24.48% of total billed charges ,74.13,26.86,,,percent of total billed charges,26.86% of total billed charges,66.24,24,,,percent of total billed charges,24% of total billed charges ,86.11,31.2,,,percent of total billed charges,31.2% of total billed charges ,220.8,80,,,percent of total billed charges,80% of total billed charges,66.24,24,,,percent of total billed charges,24% of total billed charges ,66.24,24,,,percent of total billed charges,24% of total billed charges ,66.24,220.8,
INPATIENT CONSULT EXPANDED PROBLEM,1499252,CDM,987,RC,99252,HCPCS,Outpatient,,,552,276,,148.27,26.86,,,percent of total billed charges,26.86% of total billed charges,414,75,,,percent of total billed charges,75% of total billed charges ,414,75,,,percent of total billed charges,75% of total billed charges ,5.47,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,414,75,,,percent of total billed charges,75% of total billed charges ,414,75,,,percent of total billed charges,75% of total billed charges ,441.6,80,,,percent of total billed charges,80% of total billed charges ,5.52,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,278.21,50.4,,,percent of total billed charges,50.4% of total billed charges ,414,75,,,percent of total billed charges,75% of total billed charges ,5.57,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,148.27,26.86,,,percent of total billed charges,26.86% of total billed charges,5.47,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.17,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,441.6,80,,,percent of total billed charges,80% of total billed charges,5.47,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.47,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.47,441.6,
INPATIENT CONSULT DETAILED,1499253,CDM,987,RC,99253,HCPCS,Outpatient,,,690,345,,185.33,26.86,,,percent of total billed charges,26.86% of total billed charges,517.5,75,,,percent of total billed charges,75% of total billed charges ,517.5,75,,,percent of total billed charges,75% of total billed charges ,7.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,517.5,75,,,percent of total billed charges,75% of total billed charges ,517.5,75,,,percent of total billed charges,75% of total billed charges ,552,80,,,percent of total billed charges,80% of total billed charges ,7.51,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,347.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,517.5,75,,,percent of total billed charges,75% of total billed charges ,7.58,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,185.33,26.86,,,percent of total billed charges,26.86% of total billed charges,7.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.11,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,552,80,,,percent of total billed charges,80% of total billed charges,7.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.43,552,
INPATIENT CONSULT COMPREHENSIVE,1499254,CDM,987,RC,99254,HCPCS,Outpatient,,,965,482.5,,259.2,26.86,,,percent of total billed charges,26.86% of total billed charges,723.75,75,,,percent of total billed charges,75% of total billed charges ,723.75,75,,,percent of total billed charges,75% of total billed charges ,10.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,723.75,75,,,percent of total billed charges,75% of total billed charges ,723.75,75,,,percent of total billed charges,75% of total billed charges ,772,80,,,percent of total billed charges,80% of total billed charges ,10.18,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,486.36,50.4,,,percent of total billed charges,50.4% of total billed charges ,723.75,75,,,percent of total billed charges,75% of total billed charges ,10.28,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,259.2,26.86,,,percent of total billed charges,26.86% of total billed charges,10.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.06,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,772,80,,,percent of total billed charges,80% of total billed charges,10.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.07,772,
INPATIENT CONSULT HIGH COMPLEXITY,1499255,CDM,987,RC,99255,HCPCS,Outpatient,,,1103,551.5,,296.27,26.86,,,percent of total billed charges,26.86% of total billed charges,827.25,75,,,percent of total billed charges,75% of total billed charges ,827.25,75,,,percent of total billed charges,75% of total billed charges ,14.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,827.25,75,,,percent of total billed charges,75% of total billed charges ,827.25,75,,,percent of total billed charges,75% of total billed charges ,882.4,80,,,percent of total billed charges,80% of total billed charges ,14.25,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,555.91,50.4,,,percent of total billed charges,50.4% of total billed charges ,827.25,75,,,percent of total billed charges,75% of total billed charges ,14.39,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,296.27,26.86,,,percent of total billed charges,26.86% of total billed charges,14.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.09,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,882.4,80,,,percent of total billed charges,80% of total billed charges,14.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.1,882.4,
CRITICAL CARE EVAL/MGT FIRST 30-74 MINUT,1499291,CDM,987,RC,99291,HCPCS,Outpatient,,,640.5,320.25,,172.04,26.86,,,percent of total billed charges,26.86% of total billed charges,480.38,75,,,percent of total billed charges,75% of total billed charges ,480.38,75,,,percent of total billed charges,75% of total billed charges ,21.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,480.38,75,,,percent of total billed charges,75% of total billed charges ,480.38,75,,,percent of total billed charges,75% of total billed charges ,512.4,80,,,percent of total billed charges,80% of total billed charges ,22.19,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,322.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,480.38,75,,,percent of total billed charges,75% of total billed charges ,22.41,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,172.04,26.86,,,percent of total billed charges,26.86% of total billed charges,21.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,32.84,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,512.4,80,,,percent of total billed charges,80% of total billed charges,21.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.97,512.4,
INITIAL NURSING FACILITY CARE 25 MINS,1499304,CDM,987,RC,99304,HCPCS,Outpatient,,,228.5,114.25,,61.38,26.86,,,percent of total billed charges,26.86% of total billed charges,171.38,75,,,percent of total billed charges,75% of total billed charges ,171.38,75,,,percent of total billed charges,75% of total billed charges ,6.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,171.38,75,,,percent of total billed charges,75% of total billed charges ,171.38,75,,,percent of total billed charges,75% of total billed charges ,182.8,80,,,percent of total billed charges,80% of total billed charges ,6.56,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,115.16,50.4,,,percent of total billed charges,50.4% of total billed charges ,171.38,75,,,percent of total billed charges,75% of total billed charges ,6.62,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,61.38,26.86,,,percent of total billed charges,26.86% of total billed charges,6.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.7,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,182.8,80,,,percent of total billed charges,80% of total billed charges,6.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.49,182.8,
INITIAL NURSING FACILITY PER DAY 35 MINS,1499305,CDM,987,RC,99305,HCPCS,Outpatient,,,321.5,160.75,,86.35,26.86,,,percent of total billed charges,26.86% of total billed charges,241.13,75,,,percent of total billed charges,75% of total billed charges ,241.13,75,,,percent of total billed charges,75% of total billed charges ,10.31,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,241.13,75,,,percent of total billed charges,75% of total billed charges ,241.13,75,,,percent of total billed charges,75% of total billed charges ,257.2,80,,,percent of total billed charges,80% of total billed charges ,10.41,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,162.04,50.4,,,percent of total billed charges,50.4% of total billed charges ,241.13,75,,,percent of total billed charges,75% of total billed charges ,10.51,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,86.35,26.86,,,percent of total billed charges,26.86% of total billed charges,10.31,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.41,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,257.2,80,,,percent of total billed charges,80% of total billed charges,10.31,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.31,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.31,257.2,
INITIAL NURSING FACILITY PER DAY 45 MINU,1499306,CDM,987,RC,99306,HCPCS,Outpatient,,,390.5,195.25,,104.89,26.86,,,percent of total billed charges,26.86% of total billed charges,292.88,75,,,percent of total billed charges,75% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,13.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,292.88,75,,,percent of total billed charges,75% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,312.4,80,,,percent of total billed charges,80% of total billed charges ,14.13,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,196.81,50.4,,,percent of total billed charges,50.4% of total billed charges ,292.88,75,,,percent of total billed charges,75% of total billed charges ,14.27,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,104.89,26.86,,,percent of total billed charges,26.86% of total billed charges,13.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.92,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,312.4,80,,,percent of total billed charges,80% of total billed charges,13.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.99,312.4,
SUBSEQUENT NURSING HOME CARE,1499307,CDM,987,RC,99307,HCPCS,Outpatient,,,129,64.5,,34.65,26.86,,,percent of total billed charges,26.86% of total billed charges,96.75,75,,,percent of total billed charges,75% of total billed charges ,96.75,75,,,percent of total billed charges,75% of total billed charges ,3.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,96.75,75,,,percent of total billed charges,75% of total billed charges ,96.75,75,,,percent of total billed charges,75% of total billed charges ,103.2,80,,,percent of total billed charges,80% of total billed charges ,3.09,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,65.02,50.4,,,percent of total billed charges,50.4% of total billed charges ,96.75,75,,,percent of total billed charges,75% of total billed charges ,3.13,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,34.65,26.86,,,percent of total billed charges,26.86% of total billed charges,3.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.58,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,103.2,80,,,percent of total billed charges,80% of total billed charges,3.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.06,103.2,
SUBSEQUENT NURSING CARE 15 MINS,1499308,CDM,987,RC,99308,HCPCS,Outpatient,,,174,87,,46.74,26.86,,,percent of total billed charges,26.86% of total billed charges,130.5,75,,,percent of total billed charges,75% of total billed charges ,130.5,75,,,percent of total billed charges,75% of total billed charges ,5.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,130.5,75,,,percent of total billed charges,75% of total billed charges ,130.5,75,,,percent of total billed charges,75% of total billed charges ,139.2,80,,,percent of total billed charges,80% of total billed charges ,5.63,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,87.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,130.5,75,,,percent of total billed charges,75% of total billed charges ,5.69,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,46.74,26.86,,,percent of total billed charges,26.86% of total billed charges,5.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.34,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,139.2,80,,,percent of total billed charges,80% of total billed charges,5.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.58,139.2,
SUBSEQUENT NURSING CARE 25 MINUTES,1499309,CDM,987,RC,99309,HCPCS,Outpatient,,,252.5,126.25,,67.82,26.86,,,percent of total billed charges,26.86% of total billed charges,189.38,75,,,percent of total billed charges,75% of total billed charges ,189.38,75,,,percent of total billed charges,75% of total billed charges ,8.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,189.38,75,,,percent of total billed charges,75% of total billed charges ,189.38,75,,,percent of total billed charges,75% of total billed charges ,202,80,,,percent of total billed charges,80% of total billed charges ,8.14,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,127.26,50.4,,,percent of total billed charges,50.4% of total billed charges ,189.38,75,,,percent of total billed charges,75% of total billed charges ,8.22,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,67.82,26.86,,,percent of total billed charges,26.86% of total billed charges,8.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.04,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,202,80,,,percent of total billed charges,80% of total billed charges,8.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.06,202,
SUBSEQUENT NURSING FACILITY CARE 35 MINU,1499310,CDM,987,RC,99310,HCPCS,Outpatient,,,344,172,,92.4,26.86,,,percent of total billed charges,26.86% of total billed charges,258,75,,,percent of total billed charges,75% of total billed charges ,258,75,,,percent of total billed charges,75% of total billed charges ,12.04,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,258,75,,,percent of total billed charges,75% of total billed charges ,258,75,,,percent of total billed charges,75% of total billed charges ,275.2,80,,,percent of total billed charges,80% of total billed charges ,12.16,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,173.38,50.4,,,percent of total billed charges,50.4% of total billed charges ,258,75,,,percent of total billed charges,75% of total billed charges ,12.28,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,92.4,26.86,,,percent of total billed charges,26.86% of total billed charges,12.04,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.99,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,275.2,80,,,percent of total billed charges,80% of total billed charges,12.04,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.04,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.04,275.2,
NURSING FACILITY DISCHARGE 30 MINS,1499315,CDM,987,RC,99315,HCPCS,Outpatient,,,239,119.5,,64.2,26.86,,,percent of total billed charges,26.86% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges ,179.25,75,,,percent of total billed charges,75% of total billed charges ,6.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,179.25,75,,,percent of total billed charges,75% of total billed charges ,179.25,75,,,percent of total billed charges,75% of total billed charges ,191.2,80,,,percent of total billed charges,80% of total billed charges ,6.22,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,120.46,50.4,,,percent of total billed charges,50.4% of total billed charges ,179.25,75,,,percent of total billed charges,75% of total billed charges ,6.28,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,64.2,26.86,,,percent of total billed charges,26.86% of total billed charges,6.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.21,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,191.2,80,,,percent of total billed charges,80% of total billed charges,6.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.16,191.2,
NURSING FACILITY DISCHARGE > 30 MINS,1499316,CDM,987,RC,99316,HCPCS,Outpatient,,,297.5,148.75,,79.91,26.86,,,percent of total billed charges,26.86% of total billed charges,223.13,75,,,percent of total billed charges,75% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,10.24,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,223.13,75,,,percent of total billed charges,75% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,238,80,,,percent of total billed charges,80% of total billed charges ,10.34,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,149.94,50.4,,,percent of total billed charges,50.4% of total billed charges ,223.13,75,,,percent of total billed charges,75% of total billed charges ,10.44,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,79.91,26.86,,,percent of total billed charges,26.86% of total billed charges,10.24,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.31,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,238,80,,,percent of total billed charges,80% of total billed charges,10.24,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.24,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.24,238,
SMOKING AND TOBACCO CESSATION,1499406,CDM,987,RC,99406,HCPCS,Outpatient,,,46.5,23.25,,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,1.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,34.88,75,,,percent of total billed charges,75% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,37.2,80,,,percent of total billed charges,80% of total billed charges ,1.11,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,23.44,50.4,,,percent of total billed charges,50.4% of total billed charges ,34.88,75,,,percent of total billed charges,75% of total billed charges ,1.12,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,12.49,26.86,,,percent of total billed charges,26.86% of total billed charges,1.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.64,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,37.2,80,,,percent of total billed charges,80% of total billed charges,1.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.1,37.2,
ADVANCE CARE PLANNING FIRST 30 MIN,1499497,CDM,987,RC,99497,HCPCS,Outpatient,,,212,106,,56.94,26.86,,,percent of total billed charges,26.86% of total billed charges,159,75,,,percent of total billed charges,75% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,5.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,159,75,,,percent of total billed charges,75% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,169.6,80,,,percent of total billed charges,80% of total billed charges ,6.03,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,106.85,50.4,,,percent of total billed charges,50.4% of total billed charges ,159,75,,,percent of total billed charges,75% of total billed charges ,6.09,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,56.94,26.86,,,percent of total billed charges,26.86% of total billed charges,5.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.92,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,169.6,80,,,percent of total billed charges,80% of total billed charges,5.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.97,169.6,
RPR SIMPLE LAC F/E/E/N/L 20.1-30CM,2330647,CDM,981,RC,12017,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.63,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.93,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,30.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,45.33,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,30.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.32,45.33,
DRAINAGE OF SKIN ABCESS - SIMPLE,2400001,CDM,981,RC,10060,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.15,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.23,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,8.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.06,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,8.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.07,12.06,
DRAINAGE OF SKIN ABCESS - COMPLICATED,2400002,CDM,981,RC,10061,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.66,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.84,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,17.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,26.15,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,17.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.49,26.15,
DRAINAGE OF PILONIDAL CYST,2400003,CDM,981,RC,10080,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.64,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.74,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.85,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,10.64,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.9,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,10.64,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.64,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.64,15.9,
REMOVAL FOREIGN BODY - SIMPLE,2400004,CDM,981,RC,10120,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.87,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.96,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,8.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.13,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,8.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.78,13.13,
I&D HEMATOMA/FLUID,2400005,CDM,981,RC,10140,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.51,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.63,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,11.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.04,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,11.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.4,17.04,
REMOVAL NAIL PLATE SINGLE,2400007,CDM,981,RC,11730,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.96,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.05,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.96,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.41,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.96,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.96,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.96,7.41,
DRAIN BLOOD FROM UNDER NAIL,2400008,CDM,981,RC,11740,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.11,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.13,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,2.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.12,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,2.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.09,3.12,
RPR SIMPLE LAC S/N/A/GEN/TRK <2.5,2400010,CDM,981,RC,12001,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.3,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.38,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.45,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,7.3,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.92,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,7.3,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.3,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.3,10.92,
REPAIR SIMPLE LAC S/N/A/GENTRK 2.6 - 7.5,2400011,CDM,981,RC,12002,HCPCS,Outpatient,,,251.5,125.75,,67.55,26.86,,,percent of total billed charges,26.86% of total billed charges,188.63,75,,,percent of total billed charges,75% of total billed charges ,188.63,75,,,percent of total billed charges,75% of total billed charges ,9.96,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,188.63,75,,,percent of total billed charges,75% of total billed charges ,188.63,75,,,percent of total billed charges,75% of total billed charges ,201.2,80,,,percent of total billed charges,80% of total billed charges ,10.06,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,126.76,50.4,,,percent of total billed charges,50.4% of total billed charges ,188.63,75,,,percent of total billed charges,75% of total billed charges ,10.16,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,67.55,26.86,,,percent of total billed charges,26.86% of total billed charges,9.96,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.89,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,201.2,80,,,percent of total billed charges,80% of total billed charges,9.96,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.96,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.96,201.2,
RPR SIMPLE LAC S/N/A/GEN/TRK 7.6 - 12.5,2400012,CDM,981,RC,12004,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.01,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.14,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.27,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,13.01,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.45,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,13.01,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.01,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.01,19.45,
RPR SIMPLE LAC S/N/A/TRK 12.6 - 20CM,2400013,CDM,981,RC,12005,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.74,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.92,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.1,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,17.74,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,26.52,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,17.74,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.74,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.74,26.52,
RPR SIMPLE LAC S/N./A/GEN/TRK 20.1-30CM,2400014,CDM,981,RC,12006,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.19,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.4,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,20.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.37,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,20.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.98,31.37,
RPR SIMPLE LAC F/E/E/N/L UP TO 2.5 CM,2400015,CDM,981,RC,12011,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.58,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.68,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,9.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.19,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,9.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.49,14.19,
RPR SIMPLE LAC F/E/E/N/L 2.6-5CM,2400016,CDM,981,RC,12013,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.78,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.89,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,10.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.96,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,10.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.68,15.96,
RPR SIMPLE  LAC F/E/E/N/L 5.1-7.5CM,2400017,CDM,981,RC,12014,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.17,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.31,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.45,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,14.17,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.18,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,14.17,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.17,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.17,21.18,
RPR SIMPLE LAC F/E/E/N/L 7.6-12.5CM,2400018,CDM,981,RC,12015,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.72,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.9,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.08,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,17.72,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,26.49,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,17.72,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.72,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.72,26.49,
"TRT SUPRFIL WOUND DEHIS, SIMPLE",2400019,CDM,981,RC,12020,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.53,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.74,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,21.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.87,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,21.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.32,31.87,
RPR INTERM LAC SC/AX/TR/EX 2.6-7.5CM,2400020,CDM,981,RC,12032,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.51,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.68,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.84,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,16.51,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,24.68,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,16.51,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,16.51,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,16.51,24.68,
RPR INTERM LAC NK/H/F/GN 2.6-7.5 CM,2400021,CDM,981,RC,12042,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.34,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.53,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,18.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,27.15,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,18.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,18.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,18.16,27.15,
RPR INTERM LAC NK/H/F/GN 7.6-12.5 CM,2400022,CDM,981,RC,12044,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.43,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.66,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,23.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,34.68,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,23.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.2,34.68,
RPR COMPLEX LAC SC/ARM/LG 2.6-7.5 CM,2400023,CDM,981,RC,13121,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.45,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.71,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,25.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,37.68,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,25.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,25.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,25.2,37.68,
RPR CMPLX LAC F/C/C/M/N/AX/G/H/F 1.1-2.5,2400024,CDM,981,RC,13131,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.36,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.6,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.85,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,24.36,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,36.42,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,24.36,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,24.36,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,24.36,36.42,
RPR CMPLX LAC E/N/E/L 2.6-7.5 CM,2400025,CDM,981,RC,13152,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.59,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.93,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.28,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,34.59,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,51.7,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,34.59,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,34.59,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,34.59,51.7,
BURN INITIAL VISIT - 1ST DEGREE,2400026,CDM,981,RC,16000,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.65,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.71,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,6.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.84,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,6.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.58,9.84,
DRESS/DEBRIDE THICK BURN SIMPLE,2400027,CDM,981,RC,16020,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.15,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.22,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.28,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,6.15,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.2,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,6.15,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.15,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.15,9.2,
BURN CARE PART THICK LARGE,2400028,CDM,981,RC,16030,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.8,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,19.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,29.31,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,19.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.61,29.31,
EXPLORE PENETRATED WOUND,2400029,CDM,981,RC,20103,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.27,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.75,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,48.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,72.92,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,48.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,48.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,48.78,72.92,
DRAIN/INJ JOINT/BURSA W/O US,2400030,CDM,981,RC,20605,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.5,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.54,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.66,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.46,6.66,
ORTHO MAJOR JOINT INJ,2400031,CDM,981,RC,20610,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.27,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.33,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,6.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.28,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,6.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.21,9.28,
ASPIRATE/INJ GANGLION CYST,2400032,CDM,981,RC,20612,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.96,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.01,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.06,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.96,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.41,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.96,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.96,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.96,7.41,
TRT SHOULDER DIS W/O ANESTH,2400033,CDM,981,RC,23650,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.98,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,37.35,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,36.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,54.74,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,36.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,36.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,36.61,54.74,
TREAT SHOULDER DISLOCATION,2400034,CDM,981,RC,23655,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.76,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.25,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.74,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,48.76,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,72.9,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,48.76,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,48.76,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,48.76,72.9,
CL TX ELBOW DISLOC W/O ANESTH,2400035,CDM,981,RC,24600,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,44.59,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.03,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.48,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,44.59,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,66.66,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,44.59,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,44.59,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,44.59,66.66,
"TX NURSEMAID ELBOW W/MANIP, CHILD",2400036,CDM,981,RC,24640,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.83,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.89,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,5.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.63,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,5.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.78,8.63,
CL TX DISTAL RADIAL FX W/MANIP,2400037,CDM,981,RC,25605,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,63.54,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,64.17,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,64.81,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,63.54,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,94.99,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,63.54,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,63.54,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,63.54,94.99,
TREAT FINGER DISLOCATION W/O ANESTH,2400038,CDM,981,RC,26770,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.36,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.68,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.99,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,31.36,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,46.89,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,31.36,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.36,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.36,46.89,
TREAT FINGER IP JOINT W/MANIP W/ANESTH,2400039,CDM,981,RC,26775,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.06,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.45,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,38.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,57.82,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,38.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,38.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,38.68,57.82,
TREAT KNEECAP DISLOC W/ANESTH,2400040,CDM,981,RC,27562,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60.96,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.56,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.17,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,60.96,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,91.13,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,60.96,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,60.96,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,60.96,91.13,
APPLICATION SHORT ARMED CAST,2400041,CDM,981,RC,29075,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.48,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.56,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.63,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,7.48,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.19,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,7.48,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.48,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.48,11.19,
APPLICATION LONG ARM SPLINT,2400042,CDM,981,RC,29105,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.29,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.36,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,7.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.79,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,7.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.21,10.79,
APPLICATION FOREARM SPLINT,2400043,CDM,981,RC,29125,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.62,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.67,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.84,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.58,6.84,
APPLICATION FINGER SPLINT,2400044,CDM,981,RC,29130,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.23,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.27,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.31,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.23,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.32,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.23,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.23,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.23,6.32,
SHOULDER STRAPPING,2400045,CDM,981,RC,29240,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.29,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.3,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.91,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.28,1.91,
LONG LEG SPLINT APPLICATION,2400046,CDM,981,RC,29505,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.05,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.11,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.17,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,6.05,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.05,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,6.05,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.05,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.05,9.05,
SHORT LEG SPLINT APPLICATION,2400047,CDM,981,RC,29515,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.6,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.66,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.71,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,5.6,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.37,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,5.6,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.6,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.6,8.37,
NOSE BLEED ANT CONTROL SIMPLE,2400048,CDM,981,RC,30901,HCPCS,Outpatient,,,395.5,197.75,,106.23,26.86,,,percent of total billed charges,26.86% of total billed charges,296.63,75,,,percent of total billed charges,75% of total billed charges ,296.63,75,,,percent of total billed charges,75% of total billed charges ,8.77,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,296.63,75,,,percent of total billed charges,75% of total billed charges ,296.63,75,,,percent of total billed charges,75% of total billed charges ,316.4,80,,,percent of total billed charges,80% of total billed charges ,8.86,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,199.33,50.4,,,percent of total billed charges,50.4% of total billed charges ,296.63,75,,,percent of total billed charges,75% of total billed charges ,8.95,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,106.23,26.86,,,percent of total billed charges,26.86% of total billed charges,8.77,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.12,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,316.4,80,,,percent of total billed charges,80% of total billed charges,8.77,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.77,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.77,316.4,
NOSE BLEED CONTROL COMPLEX,2400049,CDM,981,RC,30903,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.11,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.23,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,11.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.93,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,11.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.99,17.93,
NOSE BLEED POSTERIOR CONTROL INITIAL,2400050,CDM,981,RC,30905,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.37,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.53,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,16.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,24.23,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,16.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,16.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,16.21,24.23,
ENDOTRACHEAL INTUBATION,2400051,CDM,981,RC,31500,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.4,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.6,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,20.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.2,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,20.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.2,30.2,
CHEST TUBE INSERTION,2400052,CDM,981,RC,32551,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.59,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.84,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,24.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,36.4,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,24.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,24.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,24.35,36.4,
ASPIRATE PLEURA W/O IMAGING,2400053,CDM,981,RC,32554,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.44,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.54,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.65,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,10.44,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.61,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,10.44,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.44,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.44,15.61,
RPR BLOOD VESSEL LESION,2400054,CDM,981,RC,35226,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,163.03,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,164.66,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,166.29,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,163.03,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,243.74,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,163.03,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,163.03,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,163.03,243.74,
BLOOD/BLOOD PRODUCTS TRANSFUSION,2400055,CDM,981,RC,36430,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.39,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.41,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.44,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,2.39,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.57,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,2.39,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.39,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.39,3.57,
CENTRAL VENOUS CATH,2400056,CDM,981,RC,36556,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.18,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.29,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,11.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,16.54,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,11.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.06,16.54,
PICC LINE INSERTION,2400057,CDM,981,RC,36569,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.6,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.74,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.87,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,13.6,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.33,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,13.6,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.6,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.6,20.33,
BLOOD DRAW FROM VENOUS DEVICE,2400058,CDM,981,RC,36591,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.21,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.23,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.8,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.2,1.8,
BLOOD DRAW FROM CENTRAL CATH,2400059,CDM,981,RC,36592,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.27,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.29,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.3,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.27,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.9,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.27,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.27,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.27,1.9,
NEEDLE INSERT BONE CAVITY,2400060,CDM,981,RC,36680,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.07,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.17,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,9.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.91,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,9.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.97,14.91,
RPR TONGUE LACERATION,2400061,CDM,981,RC,41250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.81,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.99,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.18,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,18.81,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,28.12,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,18.81,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,18.81,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,18.81,28.12,
DRAINAGE GUM LESION,2400062,CDM,981,RC,41800,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.99,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.12,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,12.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.23,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,12.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.86,19.23,
FB REMOVAL PHARYNX,2400063,CDM,981,RC,42809,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.17,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.32,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,15.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,22.46,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,15.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.02,22.46,
NASAL/ORGASTRIC W/TUBE PLACEMENT,2400064,CDM,981,RC,43752,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.91,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.96,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.01,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.91,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.34,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.91,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.91,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.91,7.34,
I&D PERI-RECTAL ABSCESS,2400065,CDM,981,RC,46040,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.52,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.08,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.65,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,56.52,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,84.49,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,56.52,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,56.52,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,56.52,84.49,
INCISE INTERNAL HEMORROID,2400066,CDM,981,RC,46083,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.53,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.66,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,13.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.03,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,13.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.4,20.03,
ABD PARACENTESIS W/O IMAGING,2400067,CDM,981,RC,49082,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.26,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.36,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.45,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,9.26,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.85,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,9.26,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.26,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.26,13.85,
INSERT BLADDER CATH TEMP - FOLEY,2400068,CDM,981,RC,51702,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.02,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.05,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,2.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.47,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,2.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.99,4.47,
BLADDER TUBE CHANGE,2400069,CDM,981,RC,51705,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.64,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.7,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.75,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,5.64,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.43,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,5.64,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.64,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.64,8.43,
CYSTO & TREATMENT,2400070,CDM,981,RC,52310,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.53,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.7,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.88,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,17.53,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,26.2,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,17.53,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.53,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.53,26.2,
BARTHOLINS GLAND ABCESS DRAINAGE,2400071,CDM,981,RC,56420,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.3,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.42,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.54,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,12.3,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,18.38,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,12.3,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.3,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.3,18.38,
FETAL NON STRESS TEST,2400072,CDM,981,RC,59025,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.7,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.77,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.83,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,6.7,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.02,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,6.7,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.7,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.7,10.02,
VAG DELIVERY EMERGENCY,2400073,CDM,981,RC,59409,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,169.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,171.48,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,173.17,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,169.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,253.82,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,169.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,169.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,169.78,253.82,
LUMBAR PUNCTURE,2400074,CDM,981,RC,62270,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.09,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.21,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,11.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.89,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,11.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.97,17.89,
DRAIN CEREBRO SPINAL FLUID,2400075,CDM,981,RC,62272,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.9,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.1,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.3,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,19.9,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,29.75,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,19.9,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.9,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.9,29.75,
DRAIN EXT EAR ABSCESS SIMPLE,2400077,CDM,981,RC,69000,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.37,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.5,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.62,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,12.37,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,18.5,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,12.37,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.37,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.37,18.5,
CLEAR FB OUTER EAR CANAL,2400078,CDM,981,RC,69200,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.52,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.58,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.63,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,5.52,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.25,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,5.52,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.52,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.52,8.25,
REMOVE IMPACTED EAR WAX - LAVAGE UNILAT,2400079,CDM,981,RC,69209,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.85,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.86,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.87,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,0.85,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.27,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,0.85,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,0.85,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,0.85,1.27,
REMOVE IMPACTED EAR WAX BILAT,2400080,CDM,981,RC,69209,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.85,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.86,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.87,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,0.85,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.27,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,0.85,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,0.85,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,0.85,1.27,
EAR WAX REMOVAL WITH CURRETTE - UNI,2400081,CDM,981,RC,69210,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.99,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.03,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,3.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.91,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,3.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.95,5.91,
REMOVAL EAR WAX W CURRETTE BILAT,2400082,CDM,981,RC,69210,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.99,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.03,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,3.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.91,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,3.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.95,5.91,
CPR,2400083,CDM,981,RC,92950,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.53,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.73,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,20.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.38,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,20.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.32,30.38,
CARDIOVERSION ELECTRIC EXT,2400084,CDM,981,RC,92960,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.77,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.86,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.95,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,8.77,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.11,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,8.77,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.77,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.77,13.11,
THROMBOLYSIS HEART VESSEL INFUSION,2400085,CDM,981,RC,92977,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.88,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.95,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.02,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,6.88,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.28,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,6.88,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.88,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.88,10.28,
RMVL DEVITAL TIS <20CM,2400086,CDM,981,RC,97597,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.29,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.32,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.35,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,3.29,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.91,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,3.29,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.29,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.29,4.91,
ED VISIT LEVEL 1,2400087,CDM,981,RC,99281,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.47,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.49,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.18,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.46,2.18,
ED VISIT LEVEL 2,2400088,CDM,981,RC,99282,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.02,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.07,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.43,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.97,7.43,
ED VISIT LEVEL 3,2400089,CDM,981,RC,99283,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.45,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.53,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.62,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,8.45,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.63,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,8.45,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.45,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.45,12.63,
ED VISIT LEVEL 4,2400090,CDM,981,RC,99284,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.55,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.69,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,14.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.53,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,14.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.4,21.53,
ED VISIT LEVEL 5,2400091,CDM,981,RC,99285,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.07,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.28,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,20.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.18,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,20.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.86,31.18,
CRITICAL CARE 30-74 MINUTES,2400092,CDM,981,RC,99291,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.19,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.41,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,21.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,32.84,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,21.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.97,32.84,
CRITICAL CARE EA ADDL 30 MIN,2400093,CDM,981,RC,99292,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.75,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.87,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.99,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,11.75,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.57,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,11.75,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.75,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.75,17.57,
FLOUROSCOPIC GUIDANCE,2400095,CDM,981,RC,77001,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.82,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.87,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.92,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.82,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.21,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.82,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.82,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.82,7.21,
INTRAOSSEOUS NEEDLE PLACEMENT,2400097,CDM,981,RC,36680,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.07,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.17,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,9.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.91,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,9.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.97,14.91,
CHANGE PEG TUBE,2400098,CDM,981,RC,49450,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.5,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.58,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.65,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,7.5,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.22,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,7.5,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.5,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.5,11.22,
FB/FECAL IMPACTION REMOVAL,2400099,CDM,981,RC,45915,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.26,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.55,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.84,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,29.26,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,43.74,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,29.26,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,29.26,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,29.26,43.74,
ED LEVEL 1 -25,2400100,CDM,981,RC,99281,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.47,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.49,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.18,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.46,2.18,
ED VISIT LEVEL 2 - 25,2400101,CDM,981,RC,99282,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.02,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.07,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.43,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.97,7.43,
ED VISIT LEVEL 3-25,2400102,CDM,981,RC,99283,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.45,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.53,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.62,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,8.45,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.63,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,8.45,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.45,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.45,12.63,
ED VISIT LEVEL 4-25,2400103,CDM,981,RC,99284,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.55,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.69,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,14.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.53,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,14.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.4,21.53,
ED VISIT LEVEL 5 - 25,2400104,CDM,981,RC,99285,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.07,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.28,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,20.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.18,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,20.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.86,31.18,
EKG READ AND INTERP,2400105,CDM,981,RC,93010,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.62,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.63,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,0.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,0.92,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,0.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,0.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,0.61,0.92,
ED LEVEL 1 WITH 27 MODIFIER,2400106,CDM,981,RC,99281,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.47,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.49,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.18,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.46,2.18,
ED LEVEL 2 WITH -27 MODIFIER,2400107,CDM,981,RC,99282,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.02,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.07,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.43,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.97,7.43,
ED LEVEL 3 WITH 27 MODIFIER,2400108,CDM,981,RC,99283,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.45,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.53,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.62,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,8.45,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.63,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,8.45,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.45,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.45,12.63,
ED LEVEL 4 WITH 27 MODIFIER,2400109,CDM,981,RC,99284,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.55,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.69,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,14.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.53,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,14.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.4,21.53,
ED LEVEL 5 WITH 27 MODIFIER,2400110,CDM,981,RC,99285,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.07,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.28,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,20.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.18,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,20.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.86,31.18,
REPLACEMENT G TUBE,2400111,CDM,981,RC,43762,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.39,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.46,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.46,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.33,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.33,9.46,
THORACENTESIS,2400112,CDM,981,RC,32555,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.52,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.63,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,11.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.05,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,11.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.4,17.05,
RPR INTERM LACERAT F/E/E/N/L 7.6-12.5CM,2400113,CDM,981,RC,12054,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.24,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.5,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,25.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,38.83,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,25.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,25.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,25.98,38.83,
NERVE BLOCK INJ TRIGEMINAL,2400114,CDM,981,RC,64400,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.38,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.47,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.57,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,9.38,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.02,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,9.38,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.38,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.38,14.02,
DRAINAGE OF FINGER ABCESS - SIMPLE,2400115,CDM,981,RC,26010,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.37,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.51,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.65,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,14.37,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.48,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,14.37,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.37,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.37,21.48,
RPR INTERM LAC F/E/E/N/L 2.6-5CM,2400116,CDM,981,RC,12052,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.21,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.4,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,19.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,28.43,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,19.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.02,28.43,
RPR INTERM S/A/T/E 12.6 - 20.0 CM,2400117,CDM,981,RC,12035,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.73,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.03,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.34,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,30.73,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,45.94,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,30.73,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.73,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.73,45.94,
RPR INTERM LAC F/E/E/N/L  5.1-7.5 CM,2400118,CDM,981,RC,12053,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.57,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.78,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,21.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.92,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,21.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.35,31.92,
RPR INTERM S/A/T/E 7.6 - 12.5 CM,2400119,CDM,981,RC,12034,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.27,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.48,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,21.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.49,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,21.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.06,31.49,
NERVE BLOCK INJ OTHER PERIPHERAL,2400120,CDM,981,RC,64450,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.65,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.7,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.88,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.61,6.88,
RPR CMPLX LAC F/C/C/M/N/AX/G/H/F 2.6-7.5,2400121,CDM,981,RC,13132,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.5,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.8,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.09,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,29.5,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,44.11,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,29.5,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,29.5,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,29.5,44.11,
NOSE BLEED POSTERIOR CONTROL SUBSEQUENT,2400122,CDM,981,RC,30906,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.87,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.06,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.25,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,18.87,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,28.21,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,18.87,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,18.87,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,18.87,28.21,
MARSUPILATION BARTHOLINS GLAND CYST,2400123,CDM,981,RC,56440,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.38,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.62,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.85,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,23.38,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,34.96,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,23.38,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.38,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.38,34.96,
DEBRIDEMENT SUBCUTANEOUS TISSUE FIRS 20,2400124,CDM,981,RC,11042,HCPCS,Outpatient,,,246,123,,66.08,26.86,,,percent of total billed charges,26.86% of total billed charges,184.5,75,,,percent of total billed charges,75% of total billed charges ,184.5,75,,,percent of total billed charges,75% of total billed charges ,6.66,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,184.5,75,,,percent of total billed charges,75% of total billed charges ,184.5,75,,,percent of total billed charges,75% of total billed charges ,196.8,80,,,percent of total billed charges,80% of total billed charges ,6.72,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,123.98,50.4,,,percent of total billed charges,50.4% of total billed charges ,184.5,75,,,percent of total billed charges,75% of total billed charges ,6.79,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,66.08,26.86,,,percent of total billed charges,26.86% of total billed charges,6.66,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.95,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,196.8,80,,,percent of total billed charges,80% of total billed charges,6.66,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.66,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.66,196.8,
RPR INTERM LAC SC/AX/TR/EX 2.5CM/<,2400125,CDM,981,RC,12031,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.14,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,13.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.72,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,13.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.86,20.72,
INJ TRIGGER POINT 1/2 MUSCLES,2400126,CDM,981,RC,20552,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.08,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.12,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.16,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.08,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.1,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.08,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.08,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.08,6.1,
TREAT FRACTURE TRIMALLEOLAR,2400127,CDM,981,RC,27818,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.25,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.82,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.39,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,57.25,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,85.59,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,57.25,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,57.25,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,57.25,85.59,
RPR INTERM LAC NK/HNADS/FEET/GEN 2.5CM/<,2400128,CDM,981,RC,12041,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.04,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.18,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.32,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,14.04,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.99,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,14.04,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.04,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.04,20.99,
ABD PARACENTESIS W/US  IMAGING,2400129,CDM,981,RC,49083,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.68,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.79,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,10.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.81,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,10.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.58,15.81,
DRAIN/INJ JOINT/BURSA W/US,2400130,CDM,981,RC,20606,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.46,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.52,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,6.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.56,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,6.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.4,9.56,
TREAT FRACTURE METACARPAL W/MANIPULATION,2400131,CDM,981,RC,26605,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.31,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.62,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.93,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,31.31,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,46.8,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,31.31,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.31,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.31,46.8,
FINE NEEDLE ASPIRATION W/O IMAG - SIMPLE,2400132,CDM,981,RC,10021,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.85,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.92,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.99,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,6.85,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.24,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,6.85,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.85,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.85,10.24,
"BRONCHOSCOPY W/LAVAGE, INCLUDES FLUORO",2400133,CDM,981,RC,31622,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.61,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.77,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,15.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.11,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,15.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.46,23.11,
AVULSION NAIL PLATE EA ADDITIONAL,2400134,CDM,981,RC,11732,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.62,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.63,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.65,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.62,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.42,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.62,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.62,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.62,2.42,
TREAT KNUCKLE DISLOCATION W/O ANESTH,2400135,CDM,981,RC,26700,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.13,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.51,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.9,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,38.13,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,57.01,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,38.13,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,38.13,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,38.13,57.01,
REMOVAL FOREIGN BODY SQ- COMPLEX,2400136,CDM,981,RC,10121,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.64,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.84,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,20.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.55,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,20.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.43,30.55,
DEBRIDEMENT MUSCLE FIRST 20CM<,2400137,CDM,981,RC,11043,HCPCS,Outpatient,,,470.5,235.25,,126.38,26.86,,,percent of total billed charges,26.86% of total billed charges,352.88,75,,,percent of total billed charges,75% of total billed charges ,352.88,75,,,percent of total billed charges,75% of total billed charges ,19.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,352.88,75,,,percent of total billed charges,75% of total billed charges ,352.88,75,,,percent of total billed charges,75% of total billed charges ,376.4,80,,,percent of total billed charges,80% of total billed charges ,19.69,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,237.13,50.4,,,percent of total billed charges,50.4% of total billed charges ,352.88,75,,,percent of total billed charges,75% of total billed charges ,19.88,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,126.38,26.86,,,percent of total billed charges,26.86% of total billed charges,19.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,29.14,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,376.4,80,,,percent of total billed charges,80% of total billed charges,19.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.49,376.4,
DEBRIDEMENT BONE FIRST 20CM<,2400138,CDM,981,RC,11044,HCPCS,Outpatient,,,787,393.5,,211.39,26.86,,,percent of total billed charges,26.86% of total billed charges,590.25,75,,,percent of total billed charges,75% of total billed charges ,590.25,75,,,percent of total billed charges,75% of total billed charges ,31.33,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,590.25,75,,,percent of total billed charges,75% of total billed charges ,590.25,75,,,percent of total billed charges,75% of total billed charges ,629.6,80,,,percent of total billed charges,80% of total billed charges ,31.64,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,396.65,50.4,,,percent of total billed charges,50.4% of total billed charges ,590.25,75,,,percent of total billed charges,75% of total billed charges ,31.95,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,211.39,26.86,,,percent of total billed charges,26.86% of total billed charges,31.33,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,46.83,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,629.6,80,,,percent of total billed charges,80% of total billed charges,31.33,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.33,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.33,629.6,
DEBRIDEMENT SQ ADDITONAL 20CM,2400139,CDM,981,RC,11045,HCPCS,Outpatient,,,103,51.5,,27.67,26.86,,,percent of total billed charges,26.86% of total billed charges,77.25,75,,,percent of total billed charges,75% of total billed charges ,77.25,75,,,percent of total billed charges,75% of total billed charges ,3.73,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,77.25,75,,,percent of total billed charges,75% of total billed charges ,77.25,75,,,percent of total billed charges,75% of total billed charges ,82.4,80,,,percent of total billed charges,80% of total billed charges ,3.77,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,51.91,50.4,,,percent of total billed charges,50.4% of total billed charges ,77.25,75,,,percent of total billed charges,75% of total billed charges ,3.81,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,27.67,26.86,,,percent of total billed charges,26.86% of total billed charges,3.73,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.58,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,82.4,80,,,percent of total billed charges,80% of total billed charges,3.73,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.73,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.73,82.4,
DEBRIDEMENT MUSCLE ADD'L 20CM,2400140,CDM,981,RC,11046,HCPCS,Outpatient,,,186.5,93.25,,50.09,26.86,,,percent of total billed charges,26.86% of total billed charges,139.88,75,,,percent of total billed charges,75% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,8.71,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,139.88,75,,,percent of total billed charges,75% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,149.2,80,,,percent of total billed charges,80% of total billed charges ,8.8,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,94,50.4,,,percent of total billed charges,50.4% of total billed charges ,139.88,75,,,percent of total billed charges,75% of total billed charges ,8.89,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,50.09,26.86,,,percent of total billed charges,26.86% of total billed charges,8.71,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.03,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,149.2,80,,,percent of total billed charges,80% of total billed charges,8.71,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.71,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.71,149.2,
DEBRIDEMENT BONE ADDITIONAL 20CM,2400141,CDM,981,RC,11047,HCPCS,Outpatient,,,308,154,,82.73,26.86,,,percent of total billed charges,26.86% of total billed charges,231,75,,,percent of total billed charges,75% of total billed charges ,231,75,,,percent of total billed charges,75% of total billed charges ,15.93,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,231,75,,,percent of total billed charges,75% of total billed charges ,231,75,,,percent of total billed charges,75% of total billed charges ,246.4,80,,,percent of total billed charges,80% of total billed charges ,16.09,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,155.23,50.4,,,percent of total billed charges,50.4% of total billed charges ,231,75,,,percent of total billed charges,75% of total billed charges ,16.25,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,82.73,26.86,,,percent of total billed charges,26.86% of total billed charges,15.93,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.81,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,246.4,80,,,percent of total billed charges,80% of total billed charges,15.93,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.93,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.93,246.4,
"DEBRIDEMENT OF NAIL(S), ANY METHOD; 1-5",2400142,CDM,981,RC,11720,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.54,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.55,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.57,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.54,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.3,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.54,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.54,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.54,2.3,
REPAIR NAIL BED,2400143,CDM,981,RC,11760,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.37,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.48,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.58,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,10.37,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.51,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,10.37,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.37,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.37,15.51,
RPR SIMPLE LAC S/N./A/GEN/TRK >30CM,2400144,CDM,981,RC,12007,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.92,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.18,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.44,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,25.92,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,38.75,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,25.92,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,25.92,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,25.92,38.75,
RPR SIMPLE LAC F/E/E/N/L 12.6-20CM,2400145,CDM,981,RC,12016,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.94,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.18,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.42,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,23.94,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,35.79,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,23.94,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.94,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.94,35.79,
RPR SIMPLE LAC F/E/E/N/L >30CM,2400146,CDM,981,RC,12018,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.89,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.22,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.56,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,33.89,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,50.66,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,33.89,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,33.89,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,33.89,50.66,
RPR INTERM S/A/T/E 20.1-30.0 CM,2400147,CDM,981,RC,12036,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,41.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,41.69,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.1,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,41.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,61.71,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,41.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,41.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,41.28,61.71,
RPR SIMPLE LAC F/E/E/N/L 20.1-30CM,2400148,CDM,981,RC,12017,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.63,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.93,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,30.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,45.33,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,30.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.32,45.33,
RPR INTERM S/A/T/E >30.0 CM,2400149,CDM,981,RC,12037,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.36,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.85,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,50.34,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,49.36,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,73.79,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,49.36,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,49.36,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,49.36,73.79,
RPR INTERM LAC NK/H/F/GN 12.6-20.0 CM,2400150,CDM,981,RC,12045,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.94,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.28,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.62,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,33.94,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,50.75,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,33.94,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,33.94,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,33.94,50.75,
RPR INTERM LAC NK/H/F/GN 20.1-30.0 CM,2400151,CDM,981,RC,12046,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.33,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.85,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.36,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,51.33,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,76.74,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,51.33,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,51.33,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,51.33,76.74,
RPR INTERM LAC NK/H/F/GN >30.0 CM,2400152,CDM,981,RC,12047,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.55,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,59.13,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,57.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,86.66,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,57.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,57.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,57.97,86.66,
RPR INTERM LAC F/E/E/N/L 2.5CM OR LESS,2400153,CDM,981,RC,12051,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.64,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.8,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.97,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,16.64,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,24.87,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,16.64,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,16.64,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,16.64,24.87,
RPR INTERM LACERAT F/E/E/N/L 12.6-20.0CM,2400154,CDM,981,RC,12055,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.25,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.64,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,40.03,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,39.25,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,58.67,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,39.25,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,39.25,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,39.25,58.67,
RPR INTERM LACERAT F/E/E/N/L 20.1-30.0CM,2400155,CDM,981,RC,12056,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.54,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.02,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,48.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,71.84,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,48.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,48.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,48.06,71.84,
RPR INTERM LACERAT F/E/E/N/L >30.0CM,2400156,CDM,981,RC,12057,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.87,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.41,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,54.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,81.21,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,54.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,54.32,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,54.32,81.21,
RPR COMPLEX LAC TRUNK 1.1-2.5CM,2400157,CDM,981,RC,13100,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.15,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.35,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.55,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,20.15,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.12,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,20.15,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.15,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.15,30.12,
RPR COMPLEX LAC TRUNK 2.6-7.5CM,2400158,CDM,981,RC,13101,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.25,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.48,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,23.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,34.41,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,23.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.02,34.41,
RPR COMPLEX LAC TRUNK EA ADD'L 5CM OR <,2400159,CDM,981,RC,13102,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.59,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.68,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.78,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,9.59,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.33,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,9.59,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.59,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.59,14.33,
RPR COMPLEX LAC SC/ARM/LG 1.1-2.5 CM,2400160,CDM,981,RC,13120,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.82,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.04,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.26,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,21.82,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,32.62,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,21.82,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.82,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.82,32.62,
RPR COMPLEX LAC SC/ARM/LG EA  ADDL 5CM/<,2400161,CDM,981,RC,13122,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.65,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.76,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.86,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,10.65,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.92,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,10.65,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.65,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.65,15.92,
RPR CMPLX F/C/C/M/N/AX/G/H/F ADDL 5CM/<,2400162,CDM,981,RC,13133,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.53,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.68,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.82,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,14.53,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.72,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,14.53,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.53,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.53,21.72,
RPR CMPLX LAC E/N/E/L 1.1-2.5 CM,2400163,CDM,981,RC,13151,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.41,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.7,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.98,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,28.41,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,42.48,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,28.41,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,28.41,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,28.41,42.48,
RPR CMPLX LAC E/N/E/L ADDL 5CM/<,2400164,CDM,981,RC,13153,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.84,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.02,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.2,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,17.84,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,26.68,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,17.84,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.84,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.84,26.68,
BURN CARE PART THICK MEDIUM,2400165,CDM,981,RC,16025,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.15,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.29,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.43,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,14.15,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.16,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,14.15,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.15,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.15,21.16,
INJECTION SINGLE TENDON ORIGIN/INSERTION,2400166,CDM,981,RC,20551,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.51,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.55,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.6,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.51,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.74,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.51,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.51,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.51,6.74,
INJ TRIGGER POINT 3/> MUSCLES,2400167,CDM,981,RC,20553,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.65,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.7,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.88,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.61,6.88,
"DRAIN/INJ JOINT/BURSA W/O US, SMALL",2400168,CDM,981,RC,20600,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.47,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.51,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.62,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.43,6.62,
"DRAIN/INJ JOINT/BURSA W/US, SMALL",2400169,CDM,981,RC,20604,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.14,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.19,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,5.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.61,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,5.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.09,7.61,
ARTHRO MAJOR JOINT INJ W/US,2400170,CDM,981,RC,20611,HCPCS,Outpatient,,,250.5,125.25,,67.28,26.86,,,percent of total billed charges,26.86% of total billed charges,187.88,75,,,percent of total billed charges,75% of total billed charges ,187.88,75,,,percent of total billed charges,75% of total billed charges ,7.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,187.88,75,,,percent of total billed charges,75% of total billed charges ,187.88,75,,,percent of total billed charges,75% of total billed charges ,200.4,80,,,percent of total billed charges,80% of total billed charges ,7.43,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,126.25,50.4,,,percent of total billed charges,50.4% of total billed charges ,187.88,75,,,percent of total billed charges,75% of total billed charges ,7.5,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,67.28,26.86,,,percent of total billed charges,26.86% of total billed charges,7.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.99,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,200.4,80,,,percent of total billed charges,80% of total billed charges,7.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.35,200.4,
REMOVE FB SHOULDER SUBQ,2400171,CDM,981,RC,23330,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.65,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.85,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.04,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,19.65,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,29.38,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,19.65,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.65,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.65,29.38,
REMOVE FB SHOULDER DEEP,2400172,CDM,981,RC,23333,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60.95,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.55,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,60.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,90.22,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,60.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,60.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,60.35,90.22,
CLSD TX CLAVICULAR FX W/O MANIPULATION,2400173,CDM,981,RC,23500,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.82,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.06,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,23.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,35.26,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,23.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.58,35.26,
CLSD TX CLAVICULAR FX W/MANIPULATION,2400174,CDM,981,RC,23505,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.14,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.53,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.92,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,39.14,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,58.51,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,39.14,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,39.14,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,39.14,58.51,
CL TX PX HUMERAL FX W/O MANIPULATION,2400175,CDM,981,RC,23600,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.91,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.22,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.54,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,31.91,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,47.7,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,31.91,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.91,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.91,47.7,
CL TX PX HUMERAL FX W/MANIPULATION,2400176,CDM,981,RC,23605,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.93,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.45,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,52.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,78.34,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,52.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,52.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,52.4,78.34,
RMVL FB UPPER ARM/ELBOW SUBQ,2400177,CDM,981,RC,24200,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.6,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.77,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.93,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,16.6,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,24.82,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,16.6,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,16.6,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,16.6,24.82,
RMVL FB UPPER ARM/ELBOW DEEP,2400178,CDM,981,RC,24201,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.92,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.4,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,48.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,72.41,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,48.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,48.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,48.43,72.41,
CL TX HUMERAL SHAFT FX W/O MANIPULATION,2400179,CDM,981,RC,24500,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.57,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.93,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,36.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,54.12,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,36.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,36.2,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,36.2,54.12,
CL TX HUMERAL SHAFT FX W/MANIPULATION,2400180,CDM,981,RC,24505,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.72,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.28,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,56.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,83.95,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,56.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,56.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,56.16,83.95,
CL TX SPRCND/TRANSCND HUMERAL FX W/O MAN,2400181,CDM,981,RC,24530,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,38.96,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.35,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,38.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,57.67,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,38.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,38.58,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,38.58,57.67,
CL TX SPRCND/TRANSCND HUMERAL FX W/MAN,2400182,CDM,981,RC,24535,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,72.11,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,72.83,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,73.55,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,72.11,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,107.8,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,72.11,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,72.11,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,72.11,107.8,
CL TX ELBOW DISLOC W/ANESTHESIA,2400183,CDM,981,RC,24605,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.57,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,59.15,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,57.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,86.69,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,57.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,57.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,57.99,86.69,
CL TX RADIAL HEAD/NECK FX W/O MANIP,2400184,CDM,981,RC,24650,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.52,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.76,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.01,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,24.52,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,36.65,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,24.52,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,24.52,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,24.52,36.65,
CL TX RADIAL HEAD/NECK FX W/MANIP,2400185,CDM,981,RC,24655,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.08,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.56,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.04,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,48.08,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,71.87,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,48.08,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,48.08,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,48.08,71.87,
"CL TX ULNAR FX, PROX END W/O MANIP",2400186,CDM,981,RC,24670,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.44,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.72,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,28.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,42.1,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,28.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,28.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,28.16,42.1,
"CL TX ULNAR FX, PROX END W/MANIP",2400187,CDM,981,RC,24675,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.88,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,50.38,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,50.88,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,49.88,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,74.57,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,49.88,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,49.88,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,49.88,74.57,
CL TX RADIAL SHAFT FX W/O MANIP,2400188,CDM,981,RC,25500,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.75,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.02,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.29,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,26.75,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,39.99,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,26.75,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,26.75,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,26.75,39.99,
CL TX RADIAL SHAFT FX W/MANIP,2400189,CDM,981,RC,25505,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.02,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.59,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,56.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,84.4,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,56.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,56.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,56.46,84.4,
CL TX ULNAR SHAFT FX W/O MANIP,2400190,CDM,981,RC,25530,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.92,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.15,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,23.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,35.4,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,23.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.68,35.4,
CL TX ULNAR SHAFT FX W/MANIP,2400191,CDM,981,RC,25535,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.63,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.17,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,54.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,80.86,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,54.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,54.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,54.09,80.86,
CL TX RADIAL & ULNAR SHAFT FX W/O MANIP,2400192,CDM,981,RC,25560,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.43,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.71,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,27.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,40.61,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,27.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,27.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,27.16,40.61,
CL TX RADIAL & ULNAR SHAFT FX W/MANIP,2400193,CDM,981,RC,25565,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,59.52,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60.11,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60.71,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,59.52,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,88.98,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,59.52,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,59.52,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,59.52,88.98,
CL TX DISTAL RADIAL FX W/O MANIP,2400194,CDM,981,RC,25600,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.31,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.61,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.92,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,30.31,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,45.32,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,30.31,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.31,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.31,45.32,
CL TX METACARPAL FX W/O MANIP E A,2400195,CDM,981,RC,26600,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.66,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.94,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.21,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,27.66,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,41.35,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,27.66,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,27.66,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,27.66,41.35,
TX KNUCKLE DISLOCATION W/ANESTH,2400196,CDM,981,RC,26705,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.74,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.2,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,46.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,69.18,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,46.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,46.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,46.28,69.18,
TX PHALANGEAL SHFT FX W/O MAN,2400197,CDM,981,RC,26720,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.21,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.4,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,19.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,28.43,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,19.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.02,28.43,
TX PHALANGEAL SHFT FX W/MAN,2400198,CDM,981,RC,26725,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.25,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.61,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.96,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,35.25,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,52.7,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,35.25,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,35.25,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,35.25,52.7,
TX DISTAL PHALANGEAL FX W/O MAN,2400199,CDM,981,RC,26750,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.05,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.24,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.43,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,19.05,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,28.48,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,19.05,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.05,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.05,28.48,
TX DISTAL PHALANGEAL FX W/MAN,2400200,CDM,981,RC,26755,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.75,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.08,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,32.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,48.48,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,32.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,32.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,32.43,48.48,
RMVL FB PELVIS/HIP SUBQ,2400201,CDM,981,RC,27086,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.26,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.46,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,20.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,29.99,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,20.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.06,29.99,
RMVL FB PELVIS/HIP DEEP,2400202,CDM,981,RC,27087,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,94.73,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.68,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,96.63,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,94.73,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,141.63,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,94.73,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,94.73,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,94.73,141.63,
INJ SI JOINT W/GUIDE,2400203,CDM,981,RC,27096,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.69,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.77,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.84,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,7.69,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.5,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,7.69,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.69,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.69,11.5,
TX KNEE DISLOCATION W/O ANESTHESIA,2400204,CDM,981,RC,27550,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60.37,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60.97,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.57,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,60.37,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,90.25,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,60.37,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,60.37,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,60.37,90.25,
TX KNEE DISLOCATION W/ANESTHESIA,2400205,CDM,981,RC,27552,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,81.67,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,82.49,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,83.3,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,81.67,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,122.09,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,81.67,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,81.67,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,81.67,122.09,
TX PATELLAR DISLOC W/O ANESTH,2400206,CDM,981,RC,27560,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,41.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,41.62,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.03,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,41.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,61.61,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,41.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,41.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,41.21,61.61,
TX TIBIAL SHAFT FX W/O MANIPULATION,2400207,CDM,981,RC,27750,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.08,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.43,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.78,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,35.08,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,52.44,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,35.08,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,35.08,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,35.08,52.44,
TX TIBIAL SHAFT FX W/MANIPULATION,2400208,CDM,981,RC,27752,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,63.19,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,63.82,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,64.46,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,63.19,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,94.47,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,63.19,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,63.19,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,63.19,94.47,
TX MEDIAL MALLEOLUS FX W/O MANIPULATION,2400209,CDM,981,RC,27760,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.87,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.18,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.49,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,30.87,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,46.15,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,30.87,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.87,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.87,46.15,
TX MEDIAL MALLEOLUS FX W/MANIPULATION,2400210,CDM,981,RC,27762,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.79,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.34,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.9,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,55.79,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,83.4,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,55.79,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,55.79,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,55.79,83.4,
TX POS MALLEOLUS FX W/O MANIPULATION,2400211,CDM,981,RC,27767,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.22,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.49,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,26.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,40.3,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,26.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,26.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,26.95,40.3,
TX POS MALLEOLUS FX W/MANIPULATION,2400212,CDM,981,RC,27768,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.14,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.68,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.23,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,54.14,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,80.94,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,54.14,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,54.14,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,54.14,80.94,
TX FIBULA PROX/SHAFT FX W/O MANIPULATION,2400213,CDM,981,RC,27780,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.05,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.34,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.63,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,29.05,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,43.43,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,29.05,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,29.05,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,29.05,43.43,
TX FIBULA PROX/SHAFT FX W/MANIPULATION,2400214,CDM,981,RC,27781,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.84,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.31,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.77,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,46.84,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,70.02,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,46.84,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,46.84,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,46.84,70.02,
TX FIBULA DISTAL FX W/O MANIPULATION,2400215,CDM,981,RC,27786,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.39,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,29.68,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,29.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,43.51,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,29.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,29.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,29.1,43.51,
TX FIBULA DISTAL FX W/MANIPULATION,2400216,CDM,981,RC,27788,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.88,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.33,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.79,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,45.88,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,68.58,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,45.88,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,45.88,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,45.88,68.58,
TX BIMALLEOLAR ANKLE FX W/O MANIPULATION,2400217,CDM,981,RC,27808,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.82,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.13,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.44,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,30.82,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,46.08,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,30.82,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.82,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.82,46.08,
TX BIMALLEOLAR ANKLE FX W/MANIPULATION,2400218,CDM,981,RC,27810,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.82,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.36,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,54.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,81.15,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,54.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,54.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,54.28,81.15,
TX TRIMALLEOLAR ANKLE FX W/O MANIP,2400219,CDM,981,RC,27816,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.52,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.83,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,31.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,46.65,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,31.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.21,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.21,46.65,
TX WT BRG ARTC PRTN DST TIBIA FX W/O MAN,2400220,CDM,981,RC,27824,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.25,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.57,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.9,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,32.25,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,48.22,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,32.25,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,32.25,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,32.25,48.22,
TX WT BRG ARTC PRTN DST TIBIA FX W/MAN,2400221,CDM,981,RC,27825,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,64.34,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,64.98,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,65.63,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,64.34,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,96.19,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,64.34,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,64.34,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,64.34,96.19,
TX ANKLE DISLOCATION W/O ANESTHESIA,2400222,CDM,981,RC,27840,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.64,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.13,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,48.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,72,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,48.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,48.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,48.16,72,
TX ANKLE DISLOCATION W/ANESTHESIA,2400223,CDM,981,RC,27842,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.34,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.95,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.56,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,61.34,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,91.7,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,61.34,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,61.34,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,61.34,91.7,
RMVL FB FOOT SUBQ,2400224,CDM,981,RC,28190,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.57,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.69,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,11.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.13,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,11.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.46,17.13,
RMVL FB FOOT DEEP,2400225,CDM,981,RC,28192,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.42,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.68,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,26.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,39.1,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,26.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,26.16,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,26.16,39.1,
RMVL FB FOOT COMPLICATED,2400226,CDM,981,RC,28193,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.73,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.03,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,30.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,45.49,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,30.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,30.43,45.49,
TX METATARSAL FX W/O MANIPULATION EA,2400227,CDM,981,RC,28470,HCPCS,Outpatient,,,549,274.5,,147.46,26.86,,,percent of total billed charges,26.86% of total billed charges,411.75,75,,,percent of total billed charges,75% of total billed charges ,411.75,75,,,percent of total billed charges,75% of total billed charges ,17.19,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,411.75,75,,,percent of total billed charges,75% of total billed charges ,411.75,75,,,percent of total billed charges,75% of total billed charges ,439.2,80,,,percent of total billed charges,80% of total billed charges ,17.36,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,276.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,411.75,75,,,percent of total billed charges,75% of total billed charges ,17.54,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,147.46,26.86,,,percent of total billed charges,26.86% of total billed charges,17.19,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,25.7,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,439.2,80,,,percent of total billed charges,80% of total billed charges,17.19,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.19,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.19,439.2,
TX METATARSAL FX W/MANIPULATION EA,2400228,CDM,981,RC,28475,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.87,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.08,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.29,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,20.87,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.21,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,20.87,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.87,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.87,31.21,
TX GREAT TOE FX W/O MANIPULATION,2400229,CDM,981,RC,28490,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.93,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.03,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,9.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.7,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,9.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.83,14.7,
TX GREAT TOE FX W/MANIPULATION,2400230,CDM,981,RC,28495,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.7,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.82,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.94,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,11.7,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.5,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,11.7,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.7,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.7,17.5,
TX PHALANGES FX W/O MANIPULATION EA,2400231,CDM,981,RC,28510,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.06,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.15,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,8.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.41,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,8.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.97,13.41,
TX PHALANGES FX W/MANIPULATION EA,2400232,CDM,981,RC,28515,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.79,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.9,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,10.79,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,16.13,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,10.79,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.79,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.79,16.13,
CL TX METATAR-PHALNG JNT DISLOC W/ANES,2400233,CDM,981,RC,28635,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.8,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.92,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.03,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,11.8,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.64,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,11.8,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.8,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.8,17.64,
CL TX INTERPHALNG JNT DISLOC W/ANES,2400234,CDM,981,RC,28665,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.92,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.03,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.14,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,10.92,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,16.33,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,10.92,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.92,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.92,16.33,
CAST LONG ARM,2400235,CDM,981,RC,29065,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.48,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.57,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,8.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.55,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,8.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.4,12.55,
THORAX STRAPPING,2400236,CDM,981,RC,29200,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.29,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.3,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.31,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.29,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.92,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.29,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.29,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.29,1.92,
STRAPPING ELBOW OR WRIST,2400237,CDM,981,RC,29260,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.7,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.71,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.51,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.68,2.51,
STRAPPING HAND OR FINGER (BUDDY TAPE),2400238,CDM,981,RC,29280,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.49,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.51,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,2.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.68,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,2.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.46,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.46,3.68,
CAST LONG LEG,2400239,CDM,981,RC,29345,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.67,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.8,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.93,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,12.67,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,18.95,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,12.67,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.67,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.67,18.95,
CAST SHORT LEG,2400240,CDM,981,RC,29405,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.62,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.68,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.75,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,6.62,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.89,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,6.62,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.62,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.62,9.89,
STRAPPING KNEE,2400241,CDM,981,RC,29530,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.29,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.3,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.91,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.28,1.91,
STRAPPING ANKLE/FOOT,2400242,CDM,981,RC,29540,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.63,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.64,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.66,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.63,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.43,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.63,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.63,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.63,2.43,
STRAPPING TOES (BUDDY TAPE),2400243,CDM,981,RC,29550,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.08,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.09,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.1,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.08,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.61,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.08,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.08,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.08,1.61,
STRAPPING UNNA BOOT,2400244,CDM,981,RC,29580,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.39,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.42,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.46,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,3.39,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.07,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,3.39,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.39,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.39,5.07,
RMVL FB INTRANASAL,2400245,CDM,981,RC,30300,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.78,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.88,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,9.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.48,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,9.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.68,14.48,
"TRACHEOSTOMY, EMERGENT; CRICOTHYROID MEM",2400246,CDM,981,RC,31605,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.76,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.33,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.9,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,56.76,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,84.86,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,56.76,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,56.76,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,56.76,84.86,
THORACOTOMY W/EXPLORATION,2400247,CDM,981,RC,32100,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,145.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,147.44,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,148.9,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,145.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,218.24,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,145.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,145.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,145.98,218.24,
THORACOTOMY W/CNTRL HEMORRHAGE,2400248,CDM,981,RC,32110,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,268.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,271.67,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,274.36,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,268.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,402.13,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,268.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,268.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,268.98,402.13,
THORACOTOMY W/CARDIAC MASSAGE,2400249,CDM,981,RC,32160,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,137.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,138.43,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,139.8,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,137.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,204.91,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,137.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,137.06,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,137.06,204.91,
IV HEPLOCK ONLY,2400250,CDM,981,RC,36000,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.03,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.04,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.52,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.02,1.52,
VNPNXR <3 YRS FEM/JUG VEIN PHY/QHP SKILL,2400251,CDM,981,RC,36400,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.67,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.69,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.7,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.67,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.49,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.67,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.67,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.67,2.49,
VNPNXR 3 YRS/> PHY/QHP SKILL,2400252,CDM,981,RC,36410,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.03,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.04,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.52,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.02,1.52,
VNPNXR CUTDOWN <1 YR,2400253,CDM,981,RC,36420,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.71,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.8,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,9.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.37,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,9.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.61,14.37,
VNPNXR CUTDOWN >1 YR,2400254,CDM,981,RC,36425,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.27,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.32,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.38,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,5.27,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.88,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,5.27,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.27,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.27,7.88,
CENTRAL LINE <5 YRS,2400255,CDM,981,RC,36555,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.44,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.53,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.61,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,8.44,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.63,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,8.44,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.44,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.44,12.63,
RMVL FB VESTIBULE OF MOUTH SIMPLE,2400256,CDM,981,RC,40804,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.03,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.12,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.21,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,9.03,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.5,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,9.03,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.03,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.03,13.5,
RMVL FB VESTIBULE OF MOUTH COMPLICATED,2400257,CDM,981,RC,40805,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.63,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.79,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.95,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,15.63,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.37,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,15.63,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.63,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.63,23.37,
RPR POST TONGUE LAC 2.5CM/<,2400258,CDM,981,RC,41251,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.81,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.05,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.28,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,23.81,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,35.59,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,23.81,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.81,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,23.81,35.59,
RPR TONGUE LAC 2.6CM/< OR COMPLEX,2400259,CDM,981,RC,41252,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.93,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.18,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.43,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,24.93,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,37.27,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,24.93,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,24.93,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,24.93,37.27,
I&D PERITONSILLAR ABSCESS,2400260,CDM,981,RC,42700,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.44,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.57,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.71,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,13.44,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.09,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,13.44,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.44,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.44,20.09,
GASTRIC INTUBATION/ASPIRATION,2400261,CDM,981,RC,43753,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.62,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.66,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.69,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,3.62,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.42,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,3.62,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.62,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.62,5.42,
I&D PERIANAL ABSCESS,2400262,CDM,981,RC,46050,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.14,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.26,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,12.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.97,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,12.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.02,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.02,17.97,
EXC THROMBOSED HEMORRHOID XTRNL,2400263,CDM,981,RC,46320,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.24,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.38,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.53,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,14.24,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,21.29,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,14.24,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.24,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.24,21.29,
ANOSCOPY,2400264,CDM,981,RC,46600,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.6,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.64,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.69,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.6,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.87,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.6,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.6,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.6,6.87,
ANOSCOPY W/RMVL FB,2400265,CDM,981,RC,46608,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.22,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.37,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.52,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,15.22,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,22.75,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,15.22,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.22,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.22,22.75,
INSERT TEMP BLADDER CATH COMPLICATED,2400266,CDM,981,RC,51703,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.06,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.15,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,8.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.41,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,8.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.97,13.41,
MEASURE BLADDER CAPACITY VIA US,2400267,CDM,981,RC,51798,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.71,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.72,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.73,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,0.71,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.07,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,0.71,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,0.71,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,0.71,1.07,
I&D SCROTAL ABSCESS,2400268,CDM,981,RC,55100,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.68,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.86,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,18.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,27.64,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,18.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,18.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,18.49,27.64,
PLACENTA DELIVERY EMERGENCY,2400269,CDM,981,RC,59414,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.2,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.41,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,20.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,31.38,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,20.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.99,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,20.99,31.38,
INJ GREATER OCCIPITAL NERVE,2400270,CDM,981,RC,64405,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.88,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.98,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,9.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.62,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,9.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.78,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.78,14.62,
INJ PVRT FACET JT CRV/THRC 1 LVL W/IMAG,2400271,CDM,981,RC,64490,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.85,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.95,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.05,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,9.85,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,14.73,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,9.85,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.85,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,9.85,14.73,
INJ PVRT FACET JT LUM/SAC 1 LVL W/IMAG,2400272,CDM,981,RC,64493,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.29,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.38,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.46,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,8.29,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.4,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,8.29,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.29,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.29,12.4,
RMVL FB EXT EYE CONJUNCTIVAL SUPERFICIAL,2400273,CDM,981,RC,65205,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.02,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.96,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.98,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.98,2.96,
RMVL FB EXT EYE CONJUNCTIVAL EMBEDDED,2400274,CDM,981,RC,65210,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.18,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.2,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.22,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,2.18,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.26,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,2.18,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.18,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.18,3.26,
RMVL FB EXT EYE CORNEAL W/O SLIT LAMP,2400275,CDM,981,RC,65220,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.59,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.63,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.59,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.85,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.59,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.59,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.59,6.85,
RMVL FB EXT EYE CORNEAL W/SLIT LAMP,2400276,CDM,981,RC,65222,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.39,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.42,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,3.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.01,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,3.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.35,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.35,5.01,
RMV CORNEAL EPITHELIUM W/WO CHEMOCAUTERY,2400277,CDM,981,RC,65435,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.73,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.77,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.68,7,
RMV FB EYELID EMBEDDED,2400278,CDM,981,RC,67938,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.87,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.93,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,6.87,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.26,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,6.87,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.87,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.87,10.26,
TEMP TRANSCUTANEOUS PACING,2400279,CDM,981,RC,92953,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.41,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.41,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,0.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,0.6,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,0.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,0.4,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,0.4,0.6,
CARDIOVERSION ELECTRIC INT,2400280,CDM,981,RC,92961,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,43.38,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,43.81,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,42.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,64.21,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,42.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,42.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,42.95,64.21,
PACEMAKER INTERROGATION,2400281,CDM,981,RC,93288,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.45,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.47,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,2.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.63,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,2.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.43,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.43,3.63,
TRANSVENOUS PACEMAKER INSERTION,2400282,CDM,981,RC,93583,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,139.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,140.88,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,142.28,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,139.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,208.53,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,139.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,139.49,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,139.49,208.53,
EPLEY MANEUVER,2400283,CDM,981,RC,95992,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.18,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.2,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.22,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,2.18,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,3.26,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,2.18,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.18,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.18,3.26,
MODERATE SEDATION <5 YRS INITIAL 15 MIN,2400284,CDM,981,RC,99151,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.85,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.86,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.73,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.83,2.73,
MODERATE SEDATION >5 YRS INITIAL 15 MIN,2400285,CDM,981,RC,99152,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.48,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.49,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.51,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.48,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,2.21,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.48,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.48,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.48,2.21,
MODERATE SEDATION EA ADDL 15 MIN,2400286,CDM,981,RC,99153,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.11,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.12,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,1.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.64,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,1.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,1.1,1.64,
MOD SEDATION <5YRS INIT 15 MIN OTHR PHYS,2400287,CDM,981,RC,99155,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.38,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.48,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,10.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,15.37,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,10.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,10.28,15.37,
MOD SEDATION >5YRS INIT 15 MIN OTHR PHYS,2400288,CDM,981,RC,99156,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.56,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.64,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.73,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,8.56,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,12.79,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,8.56,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.56,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.56,12.79,
MOD SEDATION EA ADDL 15 MIN OTHR PHYS,2400289,CDM,981,RC,99157,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.92,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.98,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,5.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.76,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,5.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.86,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,5.86,8.76,
RPR EXTSR TENDON HAND W/O GRAFT EA,2400290,CDM,981,RC,26410,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.13,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.66,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,52.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,78.65,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,52.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,52.61,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,52.61,78.65,
RPR EXTSR TENDON FINGER W/O GRAFT EA,2400291,CDM,981,RC,26418,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.61,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.12,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,51.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,76.4,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,51.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,51.1,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,51.1,76.4,
TX HIP DISLOCATION TRAUMA W/O ANESTHESIA,2400292,CDM,981,RC,27250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.82,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.17,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,35.52,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,34.82,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,52.06,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,34.82,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,34.82,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,34.82,52.06,
TX HIP DISLOCATION TRAUMA W/ANESTHESIA,2400293,CDM,981,RC,27252,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,106.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,108.02,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,109.09,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,106.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,159.9,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,106.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,106.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,106.95,159.9,
TX HIP DISLOCATION SPONT W/O MANIP/ANEST,2400294,CDM,981,RC,27256,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,41.57,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,41.98,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.4,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,41.57,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,62.14,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,41.57,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,41.57,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,41.57,62.14,
TX HIP DISLOCATION SPONT W/MANIP/ANEST,2400295,CDM,981,RC,27257,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.05,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.58,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.11,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,53.05,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,79.31,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,53.05,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,53.05,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,53.05,79.31,
TX POST HIP ARTHROPLASTY DISLOC W/O ANES,2400296,CDM,981,RC,27265,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.82,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.37,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,54.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,81.15,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,54.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,54.28,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,54.28,81.15,
TX POST HIP ARTHROPLASTY DISLOC W/ANES,2400297,CDM,981,RC,27266,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,77.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,77.84,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,78.61,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,77.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,115.21,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,77.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,77.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,77.07,115.21,
CL TX FEMORAL SHAFT FX W/O MANIPULATION,2400298,CDM,981,RC,27500,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,63.46,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,64.09,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,62.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,93.93,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,62.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,62.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,62.83,93.93,
CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MAN,2400299,CDM,981,RC,27501,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,64.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,64.73,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,65.37,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,64.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,95.81,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,64.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,64.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,64.09,95.81,
CLTX FEM SHFT FX W/MAN W/WO TRACTION,2400300,CDM,981,RC,27502,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,110.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,111.19,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,112.29,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,110.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,164.58,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,110.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,110.09,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,110.09,164.58,
CLTX SPRCNDYLR FX W/MAN W/WO TRACTION,2400301,CDM,981,RC,27503,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,109.64,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,110.74,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,111.84,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,109.64,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,163.92,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,109.64,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,109.64,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,109.64,163.92,
CLTX FEM FX DST END MED/LAT CNDL W/O MAN,2400302,CDM,981,RC,27508,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.93,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.55,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,63.17,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,61.93,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,92.59,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,61.93,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,61.93,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,61.93,92.59,
CLTX FEM FX DST END MED/LAT CNDL W/MAN,2400303,CDM,981,RC,27510,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,96.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,97.03,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,97.99,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,96.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,143.62,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,96.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,96.07,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,96.07,143.62,
ARTL CATH/CANNUL MNTR/XFUSE/SAMPLE SPX P,2400304,CDM,981,RC,36620,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.66,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.7,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.75,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.66,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.96,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.66,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.66,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.66,6.96,
THROMBOLYSIS CEREBRAL IV INFUSION,2400305,CDM,981,RC,36620,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.66,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.7,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.75,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,4.66,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,6.96,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,4.66,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.66,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,4.66,6.96,
PERITONEAL LAVAGE W/WO IMAGING,2400306,CDM,981,RC,49084,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.15,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.35,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,19.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,29.82,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,19.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.95,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.95,29.82,
TX INTERPHALANGEAL JOINT DISLOC W/O ANES,2400307,CDM,981,RC,28660,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.95,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.06,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,11.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,17.68,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,11.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.83,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.83,17.68,
CLOSED TX TALUS FX W/O MANIPULATION,2400308,CDM,981,RC,28430,HCPCS,Outpatient,,,549,274.5,,147.46,26.86,,,percent of total billed charges,26.86% of total billed charges,411.75,75,,,percent of total billed charges,75% of total billed charges ,411.75,75,,,percent of total billed charges,75% of total billed charges ,19.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,411.75,75,,,percent of total billed charges,75% of total billed charges ,411.75,75,,,percent of total billed charges,75% of total billed charges ,439.2,80,,,percent of total billed charges,80% of total billed charges ,20.17,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,276.7,50.4,,,percent of total billed charges,50.4% of total billed charges ,411.75,75,,,percent of total billed charges,75% of total billed charges ,20.37,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,147.46,26.86,,,percent of total billed charges,26.86% of total billed charges,19.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,29.86,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,439.2,80,,,percent of total billed charges,80% of total billed charges,19.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,19.97,439.2,
CL TX CARPAL SCAPHOID FX W/O MANIP,2400309,CDM,981,RC,25622,HCPCS,Outpatient,,,853,426.5,,229.12,26.86,,,percent of total billed charges,26.86% of total billed charges,639.75,75,,,percent of total billed charges,75% of total billed charges ,639.75,75,,,percent of total billed charges,75% of total billed charges ,28.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,639.75,75,,,percent of total billed charges,75% of total billed charges ,639.75,75,,,percent of total billed charges,75% of total billed charges ,682.4,80,,,percent of total billed charges,80% of total billed charges ,28.97,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,429.91,50.4,,,percent of total billed charges,50.4% of total billed charges ,639.75,75,,,percent of total billed charges,75% of total billed charges ,29.25,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,229.12,26.86,,,percent of total billed charges,26.86% of total billed charges,28.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,42.87,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,682.4,80,,,percent of total billed charges,80% of total billed charges,28.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,28.68,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,28.68,682.4,
NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT,2400310,CDM,981,RC,54235,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.8,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.88,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.96,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,7.8,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,11.66,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,7.8,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.8,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,7.8,11.66,
TX PHALANGES FX W/O MANIPULATION EA,2440231,CDM,981,RC,28510,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.06,116.15,,,fee schedule,116.15% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.15,117.3,,,fee schedule,117.3% CMS Medicare physician fee schedule which is 101% of Medicare rates,,,,,Other,Not Separately reimbursable,8.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,13.41,149.5,,,fee schedule,149.5% CMS Medicare physician fee schedule which is 130% of Medicare rates,,,,,Other,Not Separately reimbursable,8.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.97,115,,,fee schedule,115% CMS Medicare physician fee schedule which is 100% of Medicare rates,8.97,13.41,
ANES ARTERIES FOREARM WRIST&HAND EMBOLEC,8011111,CDM,964,RC,1842,HCPCS,Outpatient,,,19.5,9.75,,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,14.63,75,,,percent of total billed charges,75% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,15.6,80,,,percent of total billed charges,80% of total billed charges ,,,,,Other,Not Separately reimbursable,9.83,50.4,,,percent of total billed charges,50.4% of total billed charges ,14.63,75,,,percent of total billed charges,75% of total billed charges ,,,,,Other,Not Separately reimbursable,5.24,26.86,,,percent of total billed charges,26.86% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.24,15.6,